Thursday June 5, 2008
Q: How many units of platelets are required to avoid possible bleeding due to 300 mg dose of Plavix (clopidogrel)?
Answer: 10 units
According to one recent work 1, pre-operative transfusion of 10 platelet concentrate units after a 300-mg clopidogrel loading or 12.5 units after a 600 mg loading may adequately reverse clopidogrel-induced platelet disaggregation to facilitate postoperative hemostasis. An additional 2.5 units fully normalized platelet function. Roughly, each unit of platelet concentrate would incrementally increase platelet count by 10, 000 uL
Editors' note: Limitation of study - the study was performed under in vitro conditions and there is a lack of information regarding the correlation with in vivo clinical outcomes, which is acknowledged by authors.
References: click to get abstract/article
1. Normalization of platelet reactivity in clopidogrel-treated subjects - Journal of Thrombosis and Haemostasis, 5: 82–90
Thursday, June 5, 2008
Wednesday, June 4, 2008
Wednesday June 4, 2008
Case: 58 year old female admitted to ICU with exacerbation of Asthma. Patient is on coumadin 5 mg per day due to previous DVT, which was continued in ICU. INR on admission was therapeutic with 2.6. Patient was intubated and started on IV steroid along with antibiotic (Ceftriazone) and other home meds. Standard ICU protocols for GI prophylaxis with esomeprazole, blood sugar control, enteral nutrion and head of bed elevation were also initiated. progressively INR continues to rise and on 6th ICU day, GI bleed developed. Which medicine may have interacted with coumadin to increase INR and subsequently GI bleed?
Answer: Esomeprazole (proton pump inhibitor)
Concomitant use of warfarin (coumadin) and esomeprazole therapy may increases INR, and supratherapeutic prothrombin time may lead to abnormal bleeding and even death. Patients treated with proton pump inhibitors and warfarin concomitantly may need to be monitored for increases in INR and prothrombin time.
References: click to get abstract/article
1. Nexium - Rxlist.com
Case: 58 year old female admitted to ICU with exacerbation of Asthma. Patient is on coumadin 5 mg per day due to previous DVT, which was continued in ICU. INR on admission was therapeutic with 2.6. Patient was intubated and started on IV steroid along with antibiotic (Ceftriazone) and other home meds. Standard ICU protocols for GI prophylaxis with esomeprazole, blood sugar control, enteral nutrion and head of bed elevation were also initiated. progressively INR continues to rise and on 6th ICU day, GI bleed developed. Which medicine may have interacted with coumadin to increase INR and subsequently GI bleed?
Answer: Esomeprazole (proton pump inhibitor)
Concomitant use of warfarin (coumadin) and esomeprazole therapy may increases INR, and supratherapeutic prothrombin time may lead to abnormal bleeding and even death. Patients treated with proton pump inhibitors and warfarin concomitantly may need to be monitored for increases in INR and prothrombin time.
References: click to get abstract/article
1. Nexium - Rxlist.com
Tuesday, June 3, 2008
Tuesday June 3, 2008
Time lag between Linezolid and Thrombocytopenia
Thrombocytopenia could be multifactorial in ICU. One of the relative new cause is Linezolid (Zyvox). But thrombocytopenia with Zyvox usually doesn't occur upto 2 weeks with the initiation of treatment and could help in ruling out atleast one reason. Relatively overall its mild, reversible and due to myelosuppression. there is no evidence for anti-platelet or interference with platelet function.
References: click to get abstract/article
1. Hematologic Effects of Linezolid: Summary of Clinical Experience - Antimicrobial Agents and Chemotherapy, August 2002, p. 2723-2726, Vol. 46, No. 8
2. Linezolid and reversible myelosuppression. - JAMA 285:1291
3. Safety, efficacy and pharmacokinetics of linezolid for treatment of resistant Gram-positive infections in cancer patients with neutropenia - Annals of Oncology 14:795-801, 2003
Time lag between Linezolid and Thrombocytopenia
Thrombocytopenia could be multifactorial in ICU. One of the relative new cause is Linezolid (Zyvox). But thrombocytopenia with Zyvox usually doesn't occur upto 2 weeks with the initiation of treatment and could help in ruling out atleast one reason. Relatively overall its mild, reversible and due to myelosuppression. there is no evidence for anti-platelet or interference with platelet function.
References: click to get abstract/article
1. Hematologic Effects of Linezolid: Summary of Clinical Experience - Antimicrobial Agents and Chemotherapy, August 2002, p. 2723-2726, Vol. 46, No. 8
2. Linezolid and reversible myelosuppression. - JAMA 285:1291
3. Safety, efficacy and pharmacokinetics of linezolid for treatment of resistant Gram-positive infections in cancer patients with neutropenia - Annals of Oncology 14:795-801, 2003
Monday, June 2, 2008
Sunday, June 1, 2008
Sunday June 1, 2008
Q; Name atleast 7 non-septic conditions which can cause low SVR (systemic vascular resistance) ?
1. Hemorrhagic (or necrotizing) Pancreatitis
2. Cirrhosis
3. Adrenal insufficiency
4. Head Injury ( initially increase SVR followed with low SVR)
5. Bactrim (TMP-SMX) in AIDS patient
6. Within 6 hours of postcardiopulmonary bypass (vasoplegic syndrome)
7. Spinal cord Injury above T6 (inhibited vagal tone)
Reference: click to get abstract/article
Low systemic vascular resistance: differential diagnosis and outcome - Critical Care 1999, 3:71-77
Q; Name atleast 7 non-septic conditions which can cause low SVR (systemic vascular resistance) ?
1. Hemorrhagic (or necrotizing) Pancreatitis
2. Cirrhosis
3. Adrenal insufficiency
4. Head Injury ( initially increase SVR followed with low SVR)
5. Bactrim (TMP-SMX) in AIDS patient
6. Within 6 hours of postcardiopulmonary bypass (vasoplegic syndrome)
7. Spinal cord Injury above T6 (inhibited vagal tone)
Reference: click to get abstract/article
Low systemic vascular resistance: differential diagnosis and outcome - Critical Care 1999, 3:71-77
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