- Pharmacoeconomic Review Report: Edoxaban (Lixiana) [BOOK]
- BOOKCanadian Agency for Drugs and Technologies in Health: Ottawa (ON)
- Edoxaban (Lixiana) is indicated for the treatment of venous thromboembolism (VTE) and the prevention of recurrent VTE.1 The dose is 60 mg once daily. The cost per day of treatment with edoxaban is $2...
Edoxaban (Lixiana) is indicated for the treatment of venous thromboembolism (VTE) and the prevention of recurrent VTE.1 The dose is 60 mg once daily. The cost per day of treatment with edoxaban is $2.84. The manufacturer submitted a cost-utility analysis conducted using a simple Markov model with eight health states: on-treatment after VTE; off-treatment; recurrent VTE; treatment after recurrent VTE; clinically relevant non-major (CRNM) bleed; intracranial hemorrhage (ICH); non-ICH major bleed; and death. In addition, three concomitant events were incorporated to capture complications related to VTE: chronic thromboembolic pulmonary hypertension (CTEPH); severe post-thrombotic syndrome (PTS); and post-ICH. Analysis did not distinguish between deep vein thrombosis (DVT) and pulmonary embolism (PE). Rather, a hybrid state of VTE was used, with results weighted by the proportion of VTE events that were DVT and PE. There are five comparators considered within the model: edoxaban, warfarin (5 mg once daily), rivaroxaban (60 mg once daily), dabigatran (150 mg twice daily), and apixaban (5 mg twice daily). Analysis comparing edoxaban versus warfarin is conducted through a direct comparison based on the Hokusai–VTE trial. Further comparison with warfarin, rivaroxaban, apixaban, and dabigatran was conducted through a network meta-analysis (NMA) provided by the manufacturer. Costs for both therapy5 and events were largely obtained from appropriate published articles or relevant databases from Ontario. Utility estimates for health states and events were obtained from relevant published literature.
- Comparison and Correlation of Magnetic Resonance Imaging and Clinical Severity in Nonhuman Immunodeficiency Virus Patients with Cryptococcal Infection of Central Nervous System. [Journal Article]
- CMChin Med J (Engl) 2018 Dec 20; 131(24):2930-2937
- CONCLUSIONS: With the increased number of the involved brain areas in patients with identifiable underlying disease, the body has lower immunity against the organism which might result in higher intracranial pressure and more severe clinical status.
- Cerebral Venous Thrombosis: An Uncommon Cause of Papilledema on Bedside Ocular Ultrasound. [Journal Article]
- JEJ Emerg Med 2018 Dec 08
- Cerebral venous thrombosis (CVT) is a rare, difficult-to-diagnose form of venous thromboembolic disease and is considered a type of stroke. Its presentation is highly variable and may be easily confu...
Cerebral venous thrombosis (CVT) is a rare, difficult-to-diagnose form of venous thromboembolic disease and is considered a type of stroke. Its presentation is highly variable and may be easily confused for more common and less debilitating or life-threatening diagnoses such as migraine, seizure, or idiopathic intracranial hypertension.
- Liberal versus conservative fluid therapy in adults and children with sepsis or septic shock. [Review]
- CDCochrane Database Syst Rev 2018 Dec 10; 12:CD010593
- CONCLUSIONS: No studies compared liberal versus conservative fluid therapy in adults. Low- to high-quality evidence indicates that liberal fluid therapy might increase mortality among children with sepsis or septic shock in hospital and at four-week follow-up. It is uncertain whether there are any differences in adverse events between liberal and conservative fluid therapy because the evidence is of low quality. Trials including adults, patients in other settings, and patients with a broader spectrum of pathogens are needed. Once published and assessed, three ongoing studies may alter the conclusions of this review.
- Optic nerve sheath diameter-guided extubation plan in obese patients undergoing robotic pelvic surgery in steep Trendelenburg position: A report of three cases. [Journal Article]
- IJIndian J Anaesth 2018; 62(11):896-899
- Robotic pelvic surgery requires steep Trendelenburg positioning with pneumoperitoneum which causes raised thoracic and intracranial pressures. In obese patients, the basal thoracic pressures are high...
Robotic pelvic surgery requires steep Trendelenburg positioning with pneumoperitoneum which causes raised thoracic and intracranial pressures. In obese patients, the basal thoracic pressures are high. Increased intrathoracic pressure can decrease the cranial venous flow leading to deficient intracranial absorption of cerebrospinal fluid and a further increase in intracranial pressure. Operating times are also longer due to unfavorable anatomy. Such patients frequently have a delayed awakening from anaesthesia due to a combination of factors such as hypercapnoea, acidosis, and raised intracranial pressures. Normocapnoea can be achieved in a ventilated patient towards the end of surgery. In cases where the anaesthetic agents have been washed out and normocapnoea has been achieved, the intracranial pressure may be an important factor causing delayed emergence. The sonographically measured optic nerve sheath diameter correlates with the intracranial pressure. We report three cases of robot-assisted pelvic surgery in obese patients where we used the optic nerve sheath diameter as a guide for the timing of extubation.
- Short-term Optic Disc Cupping Reversal in a Patient with Mild Juvenile Open-angle Glaucoma Due to Early Idiopathic Intracranial Hypertension. [Journal Article]
- JGJ Glaucoma 2018 Dec 10
- CONCLUSIONS: An unexplained reduction of optic nerve cup-to-disc ratio should prompt a workup for other etiologies, such as increased intracranial pressure. Baseline photographs not subject to computerized scan obsolescence are extremely useful in monitoring the long-term appearance of asymmetric optic discs as an adjunct to the clinical examination.
- Optic nerve appearance as a predictor of visual outcome in patients with idiopathic intracranial hypertension. [Journal Article]
- BJBr J Ophthalmol 2018 Dec 08
- CONCLUSIONS: ODH and CWS at baseline are not independent predictors of final visual function in IIH when controlling for the severity of papilloedema.
- Airway pressure release ventilation does not increase intracranial pressure in patients with traumatic brain injury with poor lung compliance. [Journal Article]
- JCJ Crit Care 2018 Dec 03; 50:118-121
- The use of Airway Pressure Release Ventilation (APRV) in patients with traumatic brain injury (TBI) remains controversial. Some believe that elevated mean airway pressures transmitted to the thorax m...
The use of Airway Pressure Release Ventilation (APRV) in patients with traumatic brain injury (TBI) remains controversial. Some believe that elevated mean airway pressures transmitted to the thorax may cause clinically significant increases in Central Venous Pressure (CVP) and intracranial pressure (ICP) from venous congestion. We perform a retrospective review from 2009 to 2015 of traumatically injured patients who were transitioned from traditional ventilator modes to APRV and also had an ICP monitor in place. Fifteen patients undergoing 19 transitions to APRV were identified. Prior to transitioning to APRV the average static and dynamic compliance was 22.9 +/- 5.6 and 16.5 +/- 4.12 mL/cm H2O. There was no statistical difference in ICP, MAP, and CPP prior to and after transition to APRV. There was a statistically significant increase in CVP, PaO2, and P:F ratio. Individually, only 4 patients had ICP values >20 in the first hour after transitioning to APRV and the rate of ICP elevations was similar between the two modes of ventilation. These data show that APRV is a viable mode of ventilation in patients with TBI who have low lung compliance. The increased CVP of this mode of ventilation did not affect ICP or hemodynamic parameters.
- Interventions affecting blood pressure variability and outcomes after intubating patients with spontaneous intracranial hemorrhage. [Journal Article]
- AJAm J Emerg Med 2018 Nov 29
- CONCLUSIONS: In addition to disease severity, individual pMVIs were significantly associated with BPV and patient outcomes. Emergency physicians should perform pMVIs more frequently to prevent BPV and improve patients' outcomes.
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- Trajectories of early secondary insults correlate to outcomes of traumatic brain injury: results from a large, single centre, observational study. [Journal Article]
- BEBMC Emerg Med 2018 Dec 05; 18(1):52
- CONCLUSIONS: After TBI, sustained hypotension and pupillary abnormalities are important determinants for patients' outcomes. Early trajectories define the dynamics of SI and contribute to a better understanding of how early recognition and treatments in emergency settings could impact on 6-month outcomes and mortality.