The American journal of emergency medicine
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The introduction of scooter-share programs across the United States has led to an increased incidence of electronic scooter (e-scooter) injuries presenting to emergency departments (EDs). As legislation begins to push scooters from the sidewalk to the street, injuries resulting from collisions between e-scooters and motor vehicles are an important, but poorly characterized consideration. This study leverages data from a national injury surveillance system to characterize e-scooter versus motor vehicle collisions resulting in ED presentation. ⋯ Electric scooter injuries involving a motor vehicle differed from those that did not across several key categories. As e-scooters and motor vehicles start to share the road more frequently, greater consideration should be made regarding how these two modes of transportation interact with each other. The promotion of thoughtful e-scooter legislation and infrastructure changes could help promote safer travel.
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Case Reports
Acute venous thromboembolism after initiation of voxelotor for treatment of sickle cell disease.
Sickle Cell Disease (SCD) is the most common genetic disease in the United States. Symptoms result from formation of sickle hemoglobin (HbS), which polymerizes and obstructs vasculature. Voxelotor, a HbS polymerization inhibitor, was granted accelerated approval by the Food and Drug Administration in 2019 for chronic treatment of SCD. ⋯ Although listed as an AE on its drug label, the only reports of voxelotor-associated VTE are in the results of clinical trials. To our knowledge, we present the first case of VTE likely provoked by voxelotor. While voxelotor offers a promising therapeutic option for SCD, emergency medicine physicians should be aware of severe AEs that may necessitate ED visits.
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Existing research recommends either andexanet alfa (AA) or four-factor prothrombin complex concentrate (4F-PCC) as an antidote for major bleeding events due to apixaban or rivaroxaban. Currently, there is limited published research that directly compares the risks and benefits of the two agents in patients with oral factor Xa inhibitor related traumatic and spontaneous intracerebral hemorrhages. Additional head-to-head data is needed to support favoring either AA or 4F-PCC when it comes to efficacy, safety, and cost. ⋯ No statistically significant differences were identified in primary or secondary outcomes between the two agents with the exception of total treatment cost. There is insufficient evidence based on this study to recommend AA over 4F-PCC for patients with intracranial hemorrhages associated with the use of apixaban or rivaroxaban.