Vitamin K antagonists (VKA) versus low-molecular-weight heparin (LMWH) for the long term treatment of symptomatic venous thromboembolism (VTE)
Alina Andras, Adriano Sala Tenna, Marlene Stewart
Moderate‐quality evidence shows no clear differences between LMWH and VKA in preventing symptomatic VTE and death after an episode of symptomatic Deep Vein Thrombosis. LMWH may represent an alternative for some patients, for example, those residing in geographically inaccessible areas, those who are unable or reluctant to visit the thrombosis service regularly, and those with contraindications to VKA.
Factor Xa inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in patients with atrial fibrillation
Karsten MH Bruins Slot, Eivind Berge
Treatment with factor Xa inhibitors significantly reduced the number of strokes and systemic embolic events compared with warfarin in people with atrial fibrillation. The absolute effect of factor Xa inhibitors compared with warfarin treatment was, however, rather small. Factor Xa inhibitors also reduced the number of intracranial haemorrhages, all‐cause deaths and major bleedings compared with warfarin.
Delayed antibiotic prescriptions for respiratory infections
Geoffrey KP Spurling, Chris B Del Mar, Liz Dooley, Ruth Foxlee, Rebecca Farley
For many clinical outcomes, there were no differences between prescribing strategies. Symptoms for acute otitis media and sore throat were modestly improved by immediate antibiotics compared with delayed antibiotics. There were no differences in complication rates. Delaying prescribing did not result in significantly different levels of patient satisfaction compared with immediate provision of antibiotics . However, delay was favoured over no antibiotics . Delayed antibiotics achieved lower rates of antibiotic use compared to immediate antibiotics (31% versus 93). Delayed antibiotics for people with acute respiratory infection reduced antibiotic use compared to immediate antibiotics, but was not shown to be different to no antibiotics in terms of symptom control and disease complications.
Plasma transfusions prior to lumbar punctures and epidural catheters for people with abnormal coagulation
Lise J Estcourt, Michael J Desborough, Carolyn Doree, Sally Hopewell, Simon J Stanworth
There is no evidence to determine whether plasma transfusions are required prior to insertion of a lumbar puncture needle or epidural catheter, and, if plasma transfusions are required, what is the degree of coagulopathy at which they should be given.
Direct oral anticoagulants (DOAC) versus warfarin for preventing stroke and systemic embolic events among atrial fibrillation (AF) patients with chronic kidney disease (CKD)
Miho Kimachi, Toshi A Furukawa, Kimihiko Kimachi, Yoshihito Goto, Shingo Fukuma, Shunichi Fukuhara
DOAC are as likely as warfarin to prevent all strokes and systemic embolic events without increasing risk of major bleeding events among AF patients with kidney impairment. These findings should encourage physicians to prescribe DOAC in AF patients with CKD without fear of bleeding.
Inhaled magnesium sulfate in the treatment of acute asthma
Rachel Knightly, Stephen J Milan, Rodney Hughes, Jennifer A Knopp-Sihota, Brian H Rowe, Rebecca Normansell, Colin Powell
Treatment with nebulised MgSO₄ may result in modest additional benefits for lung function and hospital admission when added to inhaled β₂‐agonists and ipratropium bromide. Individual studies suggest that those with more severe attacks and attacks of shorter duration may experience a greater benefit but further research into subgroups is warranted.
Corticosteroids for pneumonia
Anat Stern, Keren Skalsky, Torner Avni, Elena Carrara, Leonard Leibovici, Mica Paul
Corticosteroid therapy reduced mortality and morbidity in adults with severe comminuty-aquired pneumonia (CAP). Corticosteroid therapy reduced morbidity, but nor mortality, for adults and children with non-severe CAP. Corticostéroid therapy was associated with more adverse events, especially hyperglycaemia, but the harms did not seem to outweigh the benefits.
Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children
Amy McTague, Timothy Martland, Richard Appleton
Intravenous lorazepam and diazepam appear to be associated with similar rates of seizure cessation and respiratory depression. Although intravenous lorazepam and intravenous diazepam lead to more rapid seizure cessation, the time taken to obtain intravenous access may undermine this effect. In the absence of intravenous access, buccal midazolam or rectal diazepam are therefore acceptable first‐line anticonvulsants for the treatment of an acute tonic‐clonic convulsion that has lasted at least five minutes. There is no evidence provided by this review to support the use of intranasal midazolam or lorazepam as alternatives to buccal midazolam or rectal diazepam.
Antifibrinolytic drugs for treating primary postpartum haemorrhage
Haleema Shakur, Danielle Beaumont, Sue Pavord, Angele Gayet-Ageron, Katharine Ker, Hatem A Mousa
Tranexamic Acid (TXA) when administered intravenously reduces mortality due to bleeding in women with primary post partum haemorrhage, irrespective of mode of birth, and without increasing the risk of thromboembolic events. Taken together with the reliable evidence of the effect of TXA in trauma patients, the evidence suggests that TXA is effective if given as early as possible.
Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease (COPD)
Julia AE Walters, Daniel J Tan, Clinton J White, Richard Wood-Baker
Five days of oral corticosteroids is likely to be sufficient for treatment of adults with acute exacerbations of COPD, and this review suggests that the likelihood is low that shorter courses of systemic corticosteroids (of around five days) lead to worse outcomes than are seen with longer (10 to 14 days) courses.
Mechanical versus manual chest compressions for cardiac arrest
Peter L Wang, Steven C Brooks
The evidence does not suggest that cardio pulmonary resuscitation (CPR) protocols involving mechanical chest compression devices are superior to conventional therapy involving manual chest compressions only. We conclude on the balance of evidence that mechanical chest compression devices used by trained individuals are a reasonable alternative to manual chest compressions in settings where consistent, high‐quality manual chest compressions are not possible or dangerous for the provider.
Interventions for necrotizing soft tissue infections (NSTI) in adults
Camille Hua, Romain Bosc, Emilie Sbidian, Nicolas De Prost, Carolyn Hughes, Patricia Jabre, Olivier Chosidow, Laurence Le Cleach
Authors found very little evidence on the effects of medical and surgical treatments for NSTI. We cannot draw conclusions regarding the relative effects of any of the interventions on 30‐day mortality or serious adverse events due to the very low quality of the evidence.
Airway physical examination tests for detection of difficult airway management in apparently normal adult patients
Dominik Roth, Nathal L Pace, Anna Lee, Karent Hovhannisyan, Alexandra-Maria Warenits, Jasmin Arrich, Harald Herkner
Bedside airway examination tests, for assessing the physical status of the airway in adults with no apparent anatomical airway abnormalities, are designed as screening tests. Screening tests are expected to have high sensitivities. We found that all investigated index tests had relatively low sensitivities with high variability. The upper lip bite test showed the most favourable diagnostic test accuracy properties.
Point-of-care ultrasonography (POCS) for diagnosing thoracoabdominal injuries in patients with blunt trauma
Dirk Stengel, Johannes Leisterer, Paula Ferrada, Axel Ekkernkamp, Sven Mutze, Alexander Hoenning
In patients with suspected blunt thoracoabdominal trauma, positive POCS findings are helpful for guiding treatment decisions. However, with regard to abdominal trauma, a negative POCS exam does not rule out injuries and must be verified by a reference test such as Computerized Tomography. This is of particular importance in paediatric trauma, where the sensitivity of POCS is poor. Based on a small number of studies in a mixed population, POCS may have a higher sensitivity in chest injuries.