4- Thursday Pharmacotherapy News – 16th September

1 – A Review of Direct Oral Anticoagulants in Patients With Stage 5 or End-Stage Kidney Disease

• This study aims to evaluate the role of oral anticoagulation in patients with stage 5 chronic kidney disease (CKD-5) or end-stage kidney disease (ESKD).
• Case-control, cohort, and randomized controlled trials comparing DOACs to an active control for AF or VTE in patients with CKD-5 or ESKD and reporting outcomes of stroke, recurrent thromboembolism, or major bleeding were included.
• If OACs for stroke prevention with AF are deemed necessary, apixaban or rivaroxaban can be considered. DOACs cannot currently be recommended over warfarin in patients with CKD-5 or ESKD and VTE.

Source: SAGE Journal

2 – Effectiveness and Safety of Twice- Versus Thrice-Daily Subcutaneous Heparin for Venous Thromboembolism Prophylaxis at a Large Academic Medical Center

• Influenza viruses are responsible for seasonal epidemics and sporadic pandemics of varying severity in humans and additional treatment options are needed. High-throughput siRNA screens and an in-vivo model demonstrated that dextromethorphan (DM) has antiviral activity as a cellular target for treatment of influenza.
• This study examined DM usage and hospitalization rates among patients with laboratory-confirmed influenza in a national cohort of United States veterans.
• They aimed to evaluate the potential drug repurposing of DM as a cellular target for the management of influenza utilizing a large, national claims and electronic health record database.

Source: SAGE Journal

3 – Myth Busters: Dietary Supplements and COVID-19

• News and social media platforms have implicated dietary supplements in the treatment and prevention of coronavirus disease 2019 (COVID-19).
• During this pandemic when information quickly evolves in the presence of contradicting messages and misinformation, the role of the pharmacist is essential.
• Here, they review theoretical mechanisms and evidence related to efficacy and safety of select supplements in the setting of COVID-19, including vitamin C, vitamin D, zinc, elderberry, and silver.
• Evidence evaluating these supplements in COVID-19 patients is lacking, and providers and patients should not rely on dietary supplements to prevent or treat COVID-19.
• Rather, reference to evidence-based guidelines should guide treatment decisions.

Source: SAGE Journal

4- Hypertriglyceridemia in Critically Ill Patients With SARS-CoV-2 Infection

• Patients with SARS-CoV-2 infection could develop severe disease requiring critical care admission.
• Case reports indicated high incidence of hypertriglyceridemia (HTG) in critically ill patients infected with SARS-CoV-2, which might be related to the drugs.
• This study aims to determine the risk factors associated with HTG in this population and to investigate the relationship between HTG and lipase.
• The incidence of clinically significant HTG was high and was associated with propofol and favipiravir use.
• HTG might reflect the high inflammatory state in these patients.
• Clinicians should look at the full picture before changing therapies based only on HTG.

Source: SAGE Journal

5 – A Pragmatic Assessment of Proton-Pump Inhibitors vs. Histamine Type 2 Receptor Antagonists on Clinically Important Gastrointestinal Bleeding and Mortality When Used for Stress Ulcer Prophylaxis in the ICU

• Approximately 1-5% of critically ill patients experience clinically important gastrointestinal bleeding (CIGB).
• This study assessed the effectiveness and safety of proton-pump inhibitors (PPIs) compared to histamine type 2 receptor antagonists (H2RAs) for prevention of CIGB in mechanically ventilated patients.
• PPIs were associated with CIGB; however, the overall rate of CIGB was low.
• Compared to H2RAs, PPIs were associated with hospital mortality.
• Further identification of appropriate selection criteria for ulcer prophylaxis and comparisons of pharmacologic prevention strategies are warranted.

Source: ACCP

6 – Evaluation of Inhaled Alprostadil in Hospitalized Adult Patients

• Intermittent inhaled alprostadil (iPGE1) may be a viable alternative to inhaled nitric oxide or epoprostenol for management of right ventricular failure, pulmonary hypertension (pHTN) or acute respiratory distress syndrome (ARDS). However, limited evidence exists regarding iPGE1 use in adults, ideal dosing strategies, or optimal use cases.
• This study aims to describe the clinical characteristics of patients receiving iPGE1 and identify specific sub-populations warranting further research.
• This is the largest study to date on the use of intermittent iPGE1 in adults.
• Alprostadil was safely utilized in novel populations; however, efficacy as evaluated by clinical or surrogate endpoints could not be demonstrated and further investigation is needed to determine its potential and optimal place in therapy.

Source: SAGE Journal

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