abby

opinions are my own

[Jordan Bloom @JordanBloomMD]

One year outcomes of TAVR in young low risk patients make it into @NEJM boasting great outcomes and driving massive change in practice. @JoChikweMD and colleagues show a 220% increase in 6 year mortality for matched patients undergoing TAVR compared to SAVR. #DontDrinktheKoolAid

https://t.co/2UyDjY9tdn

[abby @amhtpharmd]

My two cents: inpatient research studies/trials should consider this before using mortality as the primary endpt in trials; morbidity endpts honor the dead & living by focusing on quality of life, rather than days alive.

[IMCrit @IM_Crit_]

Nice article about the medicalisation of dying

"Death is increasingly seen as a failure, rather than a natural stage of life"

#medtwitter

[abby @amhtpharmd]

I love conversations with my docs that start with “hey you ever heard of ______”

[Anil Makam @AnilMakam]

"weak recommendation based on low quality evidence" may be one of the most harmful things in medicine

[abby @amhtpharmd]

Building relationships is the end all be all to affect change in the workplace. Doesn’t matter how smart a person is if they can’t build trust & relationships they won’t be effective.

[Josh Farkas MD 💊 @PulmCrit]

@drjohnm interventions more resistant than cooling:

- IABP
- PCI in stable asymptomatic CAD
- 48 hour heparin gtts for medical management of NSTEMI

[abby @amhtpharmd]

@austincamp It’s that PharmD we’ve been “given” 😂🙄

[abby @amhtpharmd]

@propofolpapi661 We learn more when we are humble enough to admit when we don’t know or when we are wrong. It’s liberating & I wish it were more normalized. Constantly reminding my learners (& myself) of this

[abby @amhtpharmd]

@gaialect Healing from Hidden Abuse 🫶🏻

[abby @amhtpharmd]

I light of ANNEXa-I, I am even more excited for a [possible] TEG DOAC cartridge as I think/hope it could help us personalize whichever reversal agent we use in order to achieve max hemostasis without tipping scales to the hypercoagulable side

[abby @amhtpharmd]

@ralphadelta I appreciate the dialogue & different points of view. 💪🏼

[abby @amhtpharmd]

ANNEXA-1
(nearly) direct comparison of andexanet alfa (AA) & 4FPCC

Quick 💭
🚩multiple protocol changes
🚩 AA NNH 21 for thrombotic events (driven by MI & ischemic stroke) at 30 days (replicated effect)
🙅🏼‍♀️No difference in mRS at 30d

It’s gonna be a no from me dawg. PCC4me.

[abby @amhtpharmd]

@ralphadelta Thx for context. Difficult to choose given pages and pages of amendments. Typically excludes more patients & ⬇️ external validity. Not saying the drug doesn’t work, it
does. Inc risk of MI & isc CVA is concerning & I typically don’t view VTE ppx as effective for most MI/CVA

[NEJM @NEJM]

Presented today at #ACC24:

In the DanGer Shock trial involving patients with STEMI and cardiogenic shock, mortality at 6 months was lower with mechanical circulatory support with a microaxial flow pump than with standard care alone. Full trial results: https://t.co/3625asvzu8

[abby @amhtpharmd]

Say it louder for the people in the back 🙌🏻🧠

[IMCrit @IM_Crit_]

treatment needs to focus on re-stimulation of the GABA receptors with barbiturates (phenobarbital), benzos (lorazepam), propofol...

Dexme doesn't treat the underlying problem, it just masks the adrenergic symptoms & should never be used alone as therapy for etoh withdrawal

[IMCrit @IM_Crit_]

ICU Pharmacology Secrets - Etoh withdrawal:

I heard today from a resident (when I asked if a pt had received phenobarbital): "my attending prefers Precedex (dexmedetomidine) for etoh withdrawal"

Friendly reminder: Dexme is not etiologic treatment for etoh withdrawal. The real

[abby @amhtpharmd]

6/

Lessons learned:

🩸PV pts are at ⬆️ risk of bleeding events from acquired vWD and also at ⬆️ risk of thrombosis d/t high blood viscosity

🧪TEG was not able to detect vWD, however the TEG Platelet Map did show significant PLT inhibition & aided w treatment

👩🏼‍⚕️🧪🩸

[abby @amhtpharmd]

1/

Interesting recent cardiac surgery case.

Pt w/ hx of polycythemia vera controlled on Jakafi. Other meds were ASA 81 mg & protonix daily (hx of GIB)

Baseline Global TEG normal, however the PLT map showed ~ 30% inhibition of ADP pathway.

[abby @amhtpharmd]

5/

Which product(s) contains vWF?
- FFP
- cryo

Didn’t want to give FFP with shortened R time.

Cryo it was! Patient received two units & bleeding slowed.

Starting post operative aspirin today for graft patency 🤞🏻