In the Literature

CLINICAL SHORTS

Acute Beta-Blocker Use in Non-ST-elevation MI Decreases Mortality

This observational retrospective analysis found that patients treated with beta-blocker therapy within 24 hours of a non-ST-elevation myocardial infarction have lower rates of in-hospital mortality, reinfarction, and cardiogenic shock compared with those not treated with beta-blocker therapy.

Citation: Miller CD, Roe MT, Mulgund J, et al. Impact of acute beta-blocker therapy for patients with non-ST-segment elevation myocardial infarction. Am J Med. 2007;120:685-692.

Risk Factors Associated with Delirium among Older Patients in ICUs

This prospective cohort study identified the following risk factors for delirium within 24 hours of admission to the intensive care unit in patients older than 60: dementia, benzodiazepine therapy, elevated creatinine, and low arterial pH.

Citation: Pisani MA, Murphy TE, Van Ness PH, et al. Characteristics associated with delirium in older patients in a medical intensive care unit. Arch Intern Med. 2007; 167(15):1629-1634.

Idraparinux Inferior to Standard Therapy for VTE Treatment

Idraparinux, a subcutaneous long-acting inhibitor of factor Xa, was compared with standard therapy with heparin and adjusted-dose vitamin K antagonist for patients with acute deep venous thrombosis (DVT) or pulmonary embolism. Although Idraparinux was similar in efficacy for the treatment of DVT, it did not meet the non-inferiority requirement for the treatment of pulmonary embolism (OR, 2.14; 95% CI, 1.21 to 3.78).

Citation: The van Gogh Investigators. Idraparinux versus standard therapy for venous thromboembolic disease. N Engl J Med. 2007;357(11):1094-104.

Extended Prophylaxis of VTE with Idraparinux Effective but Associated with Major Bleeding

During a six-month extension of thrombo-prophylaxis, Idraparinux was more effective than placebo in preventing recurrent thromboembolism (1.0% versus 3.7%; p=0.002), but was associated with an increased risk of a major hemorrhage (3.1% versus 0.9%).

Citation: The van Gogh Investigators. Extended Prophylaxis of Venous Thromboembolism with Idraparinux. N Engl J Med. 2007;357(11):1105-1112.

Risk Factors for Persistent Staphylococcus aureus Bacteremia

This retrospective case-control study at a single academic medical center found the following risk factors for persistent (more than seven days) compared with nonpersistent (less than three days) S. Aureus bacteremia (pSAB): presence of Methicillin-resistant S. Aureus [MRSA], antecedent central venous catheter, chronic kidney disease, multiple sites of infection, and endocarditis.

Citation: Hawkins C, Huang J, Jin N, Noskin GA, Zembower TR, Bolon M. Persistent Staphylococcus aureus bacteremia. Arch Intern Med. 2007;167(17):1861-1867.

Hospital Workers Don’t Know Adequate Volume of Blood Required for Cultures

A survey of 360 employees at a tertiary care center revealed that 79% of healthcare providers do not know that that the current recommendation is to obtain at least 10 mL of blood per blood culture sample. Further, 44% thought the ideal measure was less than 5 mL.

Citation: Donnino MW, Goyal N, Terlecki TM, et al. Inadequate blood volume collected for culture: a survey of health care professionals. Mayo Clin Proc. 2007;82(9):1069-1072.