Background Use of Low-Molecular Weight Heparin (LMWH) has increased in the US hospitals after the... more Background Use of Low-Molecular Weight Heparin (LMWH) has increased in the US hospitals after the release of generic enoxaparin in 2010. Quality improvement projects and various professional bodies have advocated the use of LMWH over unfractionated heparin because of its superiority over unfractionated heparin for VTE prevention and because of its decreased incidence of Heparin-induced thrombocytopenia (HIT). We used a large administrative database to assess the recent trends of HIT to assess the impact of these interventions in adult hospitalized patients. Methods We used the 2009-2014 National Inpatient Sample database, which is the largest publicly available all-payer inpatient database in the US, to identify patients ≥18 years with primary and secondary diagnoses of HIT (International Classification of Diseases, 9th Revision, Clinical-Modifications [ICD-9-CM] code 289.84). Annual incidence of HIT was calculated for each year 2009-2014, fitted into a log-linear model and compared using Monte Carlo permutation test to study the changes in trend. Statistical analyses were done using STATA version 13.0 and Joinpoint Regression Program version 4.5.0.1. Results A total of 129,761 adult patients with a diagnosis (both primary and secondary) of HIT were identified during the study period. The proportion of patients who developed HIT was unchanged at 0.06 cases per 100 admissions with an annual percent change (APC) of -2.1 which was statistically not significant (95% CI: -5.7 to 1.6, p=0.02) (Figure 1). Despite the increasing awareness and ease of testing for HIT, the annual incidence of HIT with thromboses (HITT) also remained unchanged (Figure 2). There was however, an increasing total cost of hospitalization from $132,535 in 2009 to $174,253 in 2014 (APC: 6.17, 95% CI: 4.1 to 8.3, p Conclusion Despite ongoing push towards use of LMWH and country-wide quality improvement projects to encourage the use of LMWH over UFH in hospitalized patients, our data shows that the incidence of HIT remains unchanged from 2009 to 2014. Similarly, the rates of HITT and outcomes (mortality and length of stay) remain unchanged. Given the rising healthcare costs of HIT admissions and flat incidence curves, the need for more effective preventative and early diagnostic strategies, along with cost effective management options are urgently warranted
9552 Background: Immune checkpoint inhibitors (ICI) and combination chemotherapy (chemo) plus ICI... more 9552 Background: Immune checkpoint inhibitors (ICI) and combination chemotherapy (chemo) plus ICI (Chemo-ICI) have been shown in RCTs to have improved OS compared to chemo in the 1L treatment of advanced NSCLC. However, the benefit of chemo-ICI compared with ICI alone is unknown. Methods: Systematic review using MEDLINE, Embase and Cochrane CENTRAL was done to identify relevant studies up to December 2019. Phase 3 RCTs that evaluated the efficacy of 1L ICI or chemo-ICI and reported outcomes stratified by PD-L1 status (<1%, 1-49%, ≥50%) were included. ICI was defined as single-agent PD-1 axis inhibitor or dual checkpoint blockade with PD-1 axis inhibitor plus CTLA-4 inhibitor. Comparison for PD-L1<1% included chemo-ICI vs ipi/nivo and for PD-L1 1-49% and PD-L1>50% included chemo-ICI vs ipi/nivo or single-agent ICI. OS, PFS, and ORR were extracted. Network meta-analysis (NMA) was done in Bayesian random-effects regression models. Results: Ten phase 3 RCTs (7971 screened) invo...
Background Patients with immune thrombocytopenia (ITP) may be at increased risk of thromboembolis... more Background Patients with immune thrombocytopenia (ITP) may be at increased risk of thromboembolism related to different causes, including the use of thrombopoietin receptor agonists and splenectomy. Patients with ITP who develop coronary artery disease (CAD) can be a further challenge given their risk of both thromboembolism and bleeding, which may significantly increase the risk of mortality and length of stay (LOS) compared to patients who do not have ITP. We aimed to study the impact of ITP in hospital outcomes of patients with CAD. Methods We utilized the National Inpatient Sample database from years 2009 - 2011. We selected non-pregnant inpatients over the age of 18 with history of CAD. We selected patients with CAD and ITP based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). We used STATA version 13.0 (College Station, TX) for database analysis. Results A total of 4,777 cases of ITP with CAD were identified compared to 2,614,008 ...
Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome is a rare infla... more Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome is a rare inflammatory arthritis, characterised by symmetrical distal synovitis, pitting oedema of the hands and feet, absence of rheumatoid factor, and favourable response to glucocorticoids. The aim of our study is to further delineate the clinical and laboratory features, and response to treatment. We performed a systematic electronic search of Medline, PubMed, EMBASE, ACR and EULAR databases for case reports, case series, and related articles of RS3PE. Statistical analysis was done comparing categorical variables with Chi-square tests and frequencies of means via t-tests. Binary logistic regression analysis was performed to identify predictors of erosions, recurrence, malignancy and rheumatologic disorders. 331 cases of RS3PE were identified from 121 articles. RS3PE was found in older patients (71±10.42 years) predominantly in males (n= 211, 63.36%), was symmetrical (n=297/311, 95.50%) involved the...
Background Use of Low-Molecular Weight Heparin (LMWH) has increased in the US hospitals after the... more Background Use of Low-Molecular Weight Heparin (LMWH) has increased in the US hospitals after the release of generic enoxaparin in 2010. Quality improvement projects and various professional bodies have advocated the use of LMWH over unfractionated heparin because of its superiority over unfractionated heparin for VTE prevention and because of its decreased incidence of Heparin-induced thrombocytopenia (HIT). We used a large administrative database to assess the recent trends of HIT to assess the impact of these interventions in adult hospitalized patients. Methods We used the 2009-2014 National Inpatient Sample database, which is the largest publicly available all-payer inpatient database in the US, to identify patients ≥18 years with primary and secondary diagnoses of HIT (International Classification of Diseases, 9th Revision, Clinical-Modifications [ICD-9-CM] code 289.84). Annual incidence of HIT was calculated for each year 2009-2014, fitted into a log-linear model and compared using Monte Carlo permutation test to study the changes in trend. Statistical analyses were done using STATA version 13.0 and Joinpoint Regression Program version 4.5.0.1. Results A total of 129,761 adult patients with a diagnosis (both primary and secondary) of HIT were identified during the study period. The proportion of patients who developed HIT was unchanged at 0.06 cases per 100 admissions with an annual percent change (APC) of -2.1 which was statistically not significant (95% CI: -5.7 to 1.6, p=0.02) (Figure 1). Despite the increasing awareness and ease of testing for HIT, the annual incidence of HIT with thromboses (HITT) also remained unchanged (Figure 2). There was however, an increasing total cost of hospitalization from $132,535 in 2009 to $174,253 in 2014 (APC: 6.17, 95% CI: 4.1 to 8.3, p Conclusion Despite ongoing push towards use of LMWH and country-wide quality improvement projects to encourage the use of LMWH over UFH in hospitalized patients, our data shows that the incidence of HIT remains unchanged from 2009 to 2014. Similarly, the rates of HITT and outcomes (mortality and length of stay) remain unchanged. Given the rising healthcare costs of HIT admissions and flat incidence curves, the need for more effective preventative and early diagnostic strategies, along with cost effective management options are urgently warranted
9552 Background: Immune checkpoint inhibitors (ICI) and combination chemotherapy (chemo) plus ICI... more 9552 Background: Immune checkpoint inhibitors (ICI) and combination chemotherapy (chemo) plus ICI (Chemo-ICI) have been shown in RCTs to have improved OS compared to chemo in the 1L treatment of advanced NSCLC. However, the benefit of chemo-ICI compared with ICI alone is unknown. Methods: Systematic review using MEDLINE, Embase and Cochrane CENTRAL was done to identify relevant studies up to December 2019. Phase 3 RCTs that evaluated the efficacy of 1L ICI or chemo-ICI and reported outcomes stratified by PD-L1 status (<1%, 1-49%, ≥50%) were included. ICI was defined as single-agent PD-1 axis inhibitor or dual checkpoint blockade with PD-1 axis inhibitor plus CTLA-4 inhibitor. Comparison for PD-L1<1% included chemo-ICI vs ipi/nivo and for PD-L1 1-49% and PD-L1>50% included chemo-ICI vs ipi/nivo or single-agent ICI. OS, PFS, and ORR were extracted. Network meta-analysis (NMA) was done in Bayesian random-effects regression models. Results: Ten phase 3 RCTs (7971 screened) invo...
Background Patients with immune thrombocytopenia (ITP) may be at increased risk of thromboembolis... more Background Patients with immune thrombocytopenia (ITP) may be at increased risk of thromboembolism related to different causes, including the use of thrombopoietin receptor agonists and splenectomy. Patients with ITP who develop coronary artery disease (CAD) can be a further challenge given their risk of both thromboembolism and bleeding, which may significantly increase the risk of mortality and length of stay (LOS) compared to patients who do not have ITP. We aimed to study the impact of ITP in hospital outcomes of patients with CAD. Methods We utilized the National Inpatient Sample database from years 2009 - 2011. We selected non-pregnant inpatients over the age of 18 with history of CAD. We selected patients with CAD and ITP based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). We used STATA version 13.0 (College Station, TX) for database analysis. Results A total of 4,777 cases of ITP with CAD were identified compared to 2,614,008 ...
Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome is a rare infla... more Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome is a rare inflammatory arthritis, characterised by symmetrical distal synovitis, pitting oedema of the hands and feet, absence of rheumatoid factor, and favourable response to glucocorticoids. The aim of our study is to further delineate the clinical and laboratory features, and response to treatment. We performed a systematic electronic search of Medline, PubMed, EMBASE, ACR and EULAR databases for case reports, case series, and related articles of RS3PE. Statistical analysis was done comparing categorical variables with Chi-square tests and frequencies of means via t-tests. Binary logistic regression analysis was performed to identify predictors of erosions, recurrence, malignancy and rheumatologic disorders. 331 cases of RS3PE were identified from 121 articles. RS3PE was found in older patients (71±10.42 years) predominantly in males (n= 211, 63.36%), was symmetrical (n=297/311, 95.50%) involved the...
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