The American journal of medicine
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Multicenter Study Clinical Trial
Introduction of high-sensitivity troponin assays: impact on myocardial infarction incidence and prognosis.
The study objective was to compare the incidence and prognosis of acute myocardial infarction when using high-sensitivity cardiac troponin assays instead of a standard cardiac troponin assay for the diagnosis of acute myocardial infarction. ⋯ The introduction of high-sensitivity cardiac troponin assays leads to only a modest increase in the incidence of acute myocardial infarction. The novel sensitive assays identify an additional high-risk group of patients with increased mortality, therefore appropriately classified with acute myocardial infarction (Advantageous Predictors of Acute Coronary Syndromes Evaluation; NCT00470587).
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Increasingly, opioids are used to treat chronic noncancer pain. While opioids are well recognized for their effectiveness in treating acute pain, the evidence supporting the benefits for the treatment of chronic pain is less well established. Improvement of both pain and function should be considered goals of therapy. ⋯ Risk factors for poor outcomes with opioid therapy are identified, and include preexisting mental illness and dose prescribed. Recommended strategies to more safely use opioids are discussed, including tools for identifying high-risk patients. The evidence supporting the use of treatment agreements and urine drug testing to reduce the effects of adverse outcomes is limited.
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Heparin is commonly used for venous thromboembolism prophylaxis; however, the incidence of acquired thrombocytopenia in this setting has not been well described. ⋯ Thrombocytopenia occurs frequently in patients on heparin venous thromboembolism prophylaxis, yet its diagnosis has minimal impact on downstream management. The development of thrombocytopenia is associated with increased bleeding risk.
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Acute kidney injury is a frequent postoperative complication that confers increased mortality, morbidity, and costs. The purpose of this study was to evaluate whether preoperative statin use is associated with a decreased risk of postoperative acute kidney injury. ⋯ Preoperative statin use is associated with a decreased risk of postoperative acute kidney injury. Future randomized clinical trials are needed to determine causality.