Pulm/CCM – Jacobi IM Residency

jacobi July 24, 2017July 24, 2017AsideTidbitsAfib, anticoagulation, cardiology, DVT, Education, Pulm/CCM

NOACs

Antidote: Dabigatran = Idarucizumab (Praxabind) Idarucizumab for Dabigatran Reversal N Engl J Med 2015; 373:511-520 Factor Xa (Apixaban, Rivaroxaban) are POTENTIALLY reversible by Andexanet alfa (study was done in healthy human subjects, Andexanet reverses effect while infusion is running but rebounds on completion, further data will be available later) ANNEXA-4 trial N Engl J Med 2016;375:1131-41. Aripazine (PER977) is a medication currently on trial and can potentially reverse Factor Xa, dabigatran AND heparin, LMWH Use of PER977 to Reverse the Anticoagulant Effect of Edoxaban N Engl J … Continue reading “NOACs”

jacobi July 20, 2017AsideTidbitsEducation, Pulm/CCM, sepsis, shock

Pressors

Highlights from Sepsis surviving Campaign 2016: Base on ProCESS, ProMISe and ARISE trials, all 3 trials confirmed that there was no survival benefit of EGDT compared to usual resuscitation. However, in all three studies patients had early antibiotics, >30ml/kg of IVF prior to randomization. We need therefore to keep in mind that the practice has changed. Source control: empiric broad-spectrum therapy Abx to cover all likely pathogens within 1hr Initial resuscitation: 30ml/kg of IV crystalloid fluid in first 3 hours … Continue reading “Pressors”