Friday, May 25, 2018

Severely elevated BP


Thursday, May 24, 2018

Bezlotoxumab (Zinplava) for prevention of recurrent C diff


Wednesday, May 23, 2018

Acquired von Willebrand disease in severe aortic stenosis: reversal with TAVR



Highlights

•Many patients undergoing TAVI exhibit, subclinical von VWF abnormalities
•TAVI leads to a restoration of a loss of HMW VWF multimers
•Reduced markers of VWF function may aid to identify patients at increased risk for periprocedural bleeding

Abstract

Background

In this study, we sought to analyze the incidence and relevance of von Willebrand factor (VWF) abnormalities in patients undergoing transcatheter aortic valve implantation (TAVI), especially on perioperative bleeding. Furthermore, we hypothesized that, similar to aortic valve surgery, TAVI results in a restoration of VWF abnormalities.

Methods and results

We performed a prospective analysis of periinterventional VWF parameters in 74 patients (80 ± 7 years, female in 37.5%) undergoing transfemoral TAVI for severe symptomatic aortic valve stenosis. At baseline, VWF:Ag was 210 ± 90 IU/dl with a mean VWF activity of 166 ± 106 IU/dl; activity-to-antigen ratio was 0.85 ± 0.45. Heyde's syndrome (severe aortic stenosis plus GI bleeding from angiodyplasia) was observed in 2/74 (2.7%). Whereas preprocedural loss of high-molecular-weight (HMW) VWF multimers was found in thirty-six patients (48.6%), none of the patients fulfilled criteria for possible acquired VW syndrome. After TAVI, an increase of both VWF:Ag and activity compared to baseline was observed (p less than 0.01). In patients with HMW multimer loss, post-interventional recovery of multimers occurred in all cases. In the two patients with Heyde's syndrome, a trend towards reduced VWF:Ag was seen, with loss of HMW multimers in one patient. Of interest, all patients suffering from periprocedural major bleeding (5/74; 6.8%) exhibited activity-to-antigen ratios less than 0.7, indicating subclinical VWF dysfunction.

Conclusion

Whereas clinically relevant VWF dysfunction is rare, loss of HMW VWF multimers is common in TAVI patients. Similar to surgery, TAVI leads to a restoration of this loss. Furthermore, VWF parameters may be useful parameter to evaluate risk of periprocedural bleeding.



Tuesday, May 22, 2018

Varicalla zoster pneumonia: an observational study



All received acyclovir. A small number getting adjunctive steroids had worse outcomes.

Monday, May 21, 2018

A case of Wellen’s syndrome


Report and brief review here.

Sunday, May 20, 2018

The Winters formula and the thumb rule


The Winters formula is used to assess the appropriateness of the pCO2 response to metabolic acidosis (and thus determine whether a concomitant respiratory acid base disturbance exists). Here’s an interesting post from the archives of the Renal Fellow Network.

Saturday, May 19, 2018

Settled science: female physicians are better docs


So says one of the authors of the much talked about study in his somewhat, shall we say, promotional blog posts. [1] [2]