Archive for July 2012

Early coronary CTA for suspected ACS not cost effective

In this large multi center trial of patients with suspected ACS, but with non-ischemic EKG and normal troponins, they were randomized to usual evaluation or coronary CTA. The mean LOS in the hospital was reduced by 7.6 hours with CTA, but there was no difference in the overall cost of care, and there was higher radiation exposure and downstream testing in those randomized to CTA. Overall, early CTA testing for suspected ACS increased radiation exposure with no reduction in overall cost of care (abstract)

New anticoagulants versus enoxaparin after hip/knee surgery

In this large meta-analysis of randomized trials of VTE prophylaxis after hip/knee surgery, compared to enoxaparin, the risk of symptomatic VTE was lower was rivaroxaban and similar with dabigatran and apixaban; but the risk of bleeding with higher with rivaroxaban, similar with dabigatran, and lower with apixaban. Overall, the treatments did not differ on net clinical outcome (abstract).

Over-testing for PE in the ED

In this multi center observational study of imaging in patients in suspected PE, based on the NQF measure, about a third of PE testing was not necessary (those without Ddimer testing, or negative DDimer testing). The use of evidence based diagnostic testing for PE can reduce up to a third of all testing (abstract).

Risk of AMI after hip/knee surgery

This large retrospective cohort found the risk of AMI was markedly elevated within the 2 weeks after elective hip surgery (hazard ratio 26) and 2 weeks after elective knee surgery (hazard ratio 31). It remained elevated for 2-6 weeks after hip surgery (hazard ratio 5) but not for the 2-6 weeks after knee surgery (compared to controls). The authors suggest ongoing AMI risk assessment for patients up to 6 weeks after hip surgery and up to 2 weeks after knee surgery (abstract)

Pre-op alcohol cessation may reduce complications

In this small meta-analysis of 2 randomized controlled trials, pre-operative alcohol cessation reduced the odds of peri-operative complications (Odds ratio 0.22, 95% CI 0.08 to 0.61), but did not have any effect on in-hospital or 30 day mortality (abstract).