4- Thursday Pharmacotherapy News – 29th April

1 – Medication utilization among COVID-19 patients in a large, national dataset: Cerner Real-World Data™

• The outbreak of the novel coronavirus (COVID-19) required clinicians to use knowledge of therapeutic mechanisms of established drugs to piece together treatment regimens.
• The purpose of this study is to examine the trends in medication utilization among COVID-19 patients across the United States using a national dataset.
• This study is the first of its kind to assess trends in medication utilization in a national dataset and is the first large descriptive study of pharmacotherapy in hospitalized COVID-19 patients.
• It provides an important glimpse into prescribing patterns during a novel pandemic

Source: ScienceDirect

2 – Smoking and Risk of COVID-19 Hospitalization

• Since first being recognized in December 2019, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV2) has caused to date 130 million cases and 2.8 million deaths worldwide
• Smoking has been associated with increased risk of infection and worse outcomes for a multitude of bacterial and viral pathogens
• Former smokers are at higher risk for hospitalization and death from COVID-19 than current or never smokers.
• The increase in risk of hospitalization seen among former smokers is mediated through older age and higher comorbidity burden.

Source: ScienceDirect

3 – Use of Remdesivir in Myasthenia Gravis and COVID‐19

• Myasthenia gravis and the associated pharmacologic management options could place patients at higher risk of contracting severe acute respiratory syndrome coronavirus 2 and exhibiting more severe manifestations of the novel coronavirus disease 2019 (COVID‐19).
• Multiple agents have been studied for the management of the COVID‐19, including remdesivir.
• This study describe the first reported clinical course of three patients with myasthenia gravis who safely received remdesivir in combination with dexamethasone for the management of COVID‐

Source: ACCP

4- Achievement of goal anti‐Xa activity with weight‐based enoxaparin dosing for venous thromboembolism prophylaxis in trauma patients

• Trauma patients are at an increased risk of developing venous thromboembolism (VTE), and enoxaparin is considered the standard of care for VTE prophylaxis in this population.
• Although there is literature to suggest higher doses of enoxaparin are more effective in achieving goal anti‐Xa levels, there is limited information regarding the use of weight‐based dosing across all weights in the trauma population.
• The purpose of this study was to evaluate the utility of routine anti‐Xa peak monitoring for trauma patients initiated on weight‐based enoxaparin for VTE prophylaxis and identify patient populations where monitoring is necessary.

Source: ACCP

5 – Low dose versus standard dose four factor prothrombin complex concentrate for factor‐Xa inhibitor reversal in spontaneous and traumatic intracranial hemorrhage

• Current neurocritical care guidelines recommend 50 IU/kg four factor prothrombin complex concentrate (4PCC) for factor Xa inhibitor (FXaI) reversal in intracranial hemorrhage (ICH) based on few clinical studies conducted among non‐ICH subjects.
• The purpose of this study is to determine if there is a difference in hemostatic efficacy between 25 IU/kg versus 50 IU/kg 4PCC for FXaI reversal in ICH.
• For the reversal of FXaI in ICH, a 25 IU/kg dose may be an effective alternative to 50 IU/kg 4PCC dosing.

Source: ACCP

6 – Performance of nasal methicillin‐resistant Staphylococcus aureus screening for intra‐abdominal infections in critically ill adult patients

• Intra‐abdominal infections (IAIs) are a common reason for intensive care unit (ICU) admissions, and methicillin‐resistant Staphylococcus aureus (MRSA) is an uncommon pathogen in IAIs.
• Although more data are available in the setting of non‐abdominal sources, there are limited data on the performance of nasal MRSA screening for MRSA IAIs.
• The primary objective of this study was to evaluate the performance of nasal MRSA screening for MRSA IAIs in critically ill adult patients.
• Among critically ill adult patients with IAIs, a negative nasal MRSA screen within 30 days may help to empirically exclude MRSA as a causative pathogen.

Source: ACCP

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