The American journal of medicine
-
The vitamin K antagonist, warfarin, is the most commonly prescribed oral anticoagulant. Use of warfarin is associated with an increase in systemic calcification, including in the coronary and peripheral vasculature. ⋯ Warfarin-induced systemic calcification can result in adverse clinical effects. In this review article, we highlight some of the key translational and clinical studies that associate warfarin with vascular calcification.
-
Since 1960, the Advisory Committee on Immunization Practices has recommended influenza vaccination for adults with certain high-risk conditions because of increased risk for complications from influenza infection. We assessed national influenza vaccination among persons ages 18-64 years with high-risk conditions. ⋯ Influenza vaccination coverage varies substantially by age and high-risk conditions but remains low. Approximately 50% of those with high-risk conditions remain unvaccinated. Health care providers should ensure they routinely assess influenza vaccination status, and recommend and offer vaccines to those with high-risk conditions.
-
The objective was to study whether the temporal pattern of transient hyponatremia development in acute heart failure might provide insight into its pathophysiology and prognostic relevance. ⋯ Transient hyponatremia is prognostically relevant, but it has a heterogeneous cause according to its temporal pattern of development.
-
Gastrointestinal bleeding is a well-known risk of systemic anticoagulation. However, bleeding in the setting of supratherapeutic anticoagulation may have a milder natural history than unprovoked bleeding. It is a common clinical gestalt that endoscopy is common, but bleeding source identification or intervention is uncommon, yet few data exist to inform this clinical impression. Consequently, we sought to examine our institutional experience with gastrointestinal bleeding in the setting of supratherapeutic international normalized ratio (INR) with the aim of identifying predictors of endoscopically identifiable lesions, interventions, and outcomes. ⋯ This study demonstrates that the relationship between INR elevation and identification of a bleeding source or endoscopic intervention at EGD are indeed antiparallel. Concomitant antiplatelet therapy increases the likelihood of bleeding source identification and intervention, as does EGD within 12 hours of presentation. However, regardless of source identification or endoscopic intervention, important clinical outcomes were unchanged, suggesting that decisions about endoscopy should be made on a case-by-case basis, particularly in patients with INR > 7.5. Future prospective studies on appropriate indications and timing of endoscopy in such patients are warranted.