Only about half of patients with alcohol use disorder who are admitted to ICU receive thiamine

1. Only about half of patients with alcohol use disorder who are admitted to ICU receive thiamine

Abstract: https://www.acpjournals.org/doi/10.7326/M21-2103

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An observational study of patients with alcohol use disorder (AUD) admitted to intensive care units throughout the United States found that almost half of the people evaluated did not receive thiamine (also called vitamin B1) supplementation. Patients with AUD who were admitted for reasons other than alcohol withdrawal had both a numerically lower incidence and lower predicted probability of receiving thiamine than those admitted for alcohol withdrawal. The findings are published in Annals of Internal Medicine.

Thiamine deficiency can cause several life-threatening disorders including the Wernicke–Korsakoff syndrome, a degenerative disorder of the brain. Left untreated, thiamine deficiency can result in death or potentially irreversible neurological damage. Patients with AUD are known to have an increased risk for thiamine deficiency disorders and current guidelines recommend supplementation in this population. However, despite guidelines recommending thiamine supplementation for patients with AUD, limited data exists regarding how patients are treated by clinicians in the critical care setting.

Researchers from Beth Israel Deaconess Medical Center studied health records for nearly 15,000 patients with AUD and various critical illnesses, including alcohol withdrawal, septic shock, traumatic brain injury (TBI), and diabetic ketoacidosis (DKA) to describe how often thiamine supplementation was provided. The researchers found that overall, only about half of patients with AUD received thiamine supplementation. Those who presented with alcohol withdrawal were more likely to received thiamine (59 percent) than those with TBI (41 percent), septic shock (26 percent), and DKA (24 percent).

According to the researchers, these findings highlight a need for increased awareness of the need for thiamine supplementation, especially for patients with AUD who are admitted to the ICU with sepsis and other forms of critical illness. They further suggest that these findings reveal a potential area for quality improvement.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author, Michael W. Donnino MD, please contact Chloe Meck at cmeck@bilh.org.

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2. Bentonite hemostatic powder works as well as standard care for treating gastrointestinal bleeding

Abstract: https://www.acpjournals.org/doi/10.7326/M21-0975

Editorial: https://www.acpjournals.org/doi/10.7326/M21-4267

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A noninferiority trial found that TC-325, a bentonite hemostatic powder with aluminum phyllosilicate clay, works as well as standard care for endoscopic control of bleeding from nonvariceal upper gastrointestinal causes. The study is published in Annals of Internal Medicine.

Use of TC-325 has been associated with both a high initial rate of hemostasis and recurrent bleeding after initial treatment. However, only two prior studies have compared TC-325 with conventional treatment in patients with acute nonvariceal upper gastrointestinal bleeding.

Researchers from Prince of Wales Hospital, Hong Kong, enrolled 224 patients with gastroduodenal ulcers in the trial. The patients were randomly assigned to receive either TC-325 (n-111) or standard hemostatic treatment (n=113). Of the patients assigned to the TC-325 group, 90.1 percent had their bleeding controlled within 30 days. Out of the total patients assigned to the standard treatment group, 81.4 percent of patients had their bleeding controlled within 30 days. According to the researchers, these findings suggest that TC-325 may be used as one of the first endoscopic treatments in patients with active bleeding from nonvariceal upper gastrointestinal lesions and can also be considered when other treatments have failed.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, James Y.W. Lau, MD, please contact the media office at newsdo@ha.org.hk.

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3. Telehealth visits as effective as in-person care for many common health conditions

Abstract: https://www.acpjournals.org/doi/10.7326/M21-3511

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A review of published evidence suggests that video teleconferencing (VTC) is an effective alternative to in-person health care services, with regard to clinical effectiveness, patient satisfaction, and quality of life for many common health conditions. The review is published in Annals of Internal Medicine.

Despite increased use of VTC services, concerns exist about the safety, effectiveness, and accuracy of telemedicine. Evidence from prior reviews of these services is outdated, unclear, or missing.

Researchers from RTI International, Research Triangle Park, North Carolina systematically evaluated recent evidence of the benefits and harms of VTC visits for disease prevention, diagnosis, and treatment and developed an evidence map describing gaps in the evidence. The research team found 20 studies that met the inclusion criteria, had low or moderate risk of bias, and included at least 50 participating patients. The studies varied in context of diseases studied, reasons for care, intervention components, comparison groups, sample size, and outcomes. The review found that replacing or augmenting usual care with VTC generally results in similar outcomes. However, the evidence was limited, with only five disease categories represented by multiple studies, including diabetes (4 studies), respiratory illnesses (4 studies), pain-related disorders (4 studies), cardiovascular conditions (3 studies), and neurological conditions (2 studies).

According to the authors, these findings provide some evidence for how physicians and policymakers can safely implement the use of VTC as a replacement for or to augment usual care. However, the body of evidence remains limited to the disease conditions studied, and little is known about whether these benefits vary by subgroups, sociodemographic characteristics, or social determinants of health. Additional research is needed to address important research gaps.

Media contacts For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the lead author, Jordan Albritton, PhD, MPH, please contact the RTI newsroom at news@rti.org.

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4. Apixaban shows superior effectiveness and safety compared to rivaroxaban for new users with VTE

Abstract: https://www.acpjournals.org/doi/10.7326/M21-0717

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A cohort study found that adults with venous thromboembolism (VTE) who initiated treatment with apixaban had a lower rate of recurrent VTE and intracranial and gastrointestinal bleeding events compared with those who first initiated treatment with rivaroxaban. The findings are published in Annals of Internal Medicine.

VTE affects 100 out of every 100,000 people per year. Approximately one-quarter of those patients experience recurrent bleeding within five years of their diagnosis. Anticoagulants are part of the recommended course of treatment to reduce the likelihood of recurrent VTE. Direct oral anticoagulants (DOACs) including apixaban and rivaroxaban are increasingly prescribed for patients with VTE.

Researchers from the University of Pennsylvania analyzed health records for approximately 37,000 VTE patients who were prescribed either apixaban or rivaroxaban as part of their course of treatment. The patients selected were older adults with comorbid conditions including hyperlipidemia, chronic kidney disease, and liver disease. Of the 18,618 patients prescribed apixaban, 475 had recurrent VTE and 386 had gastrointestinal or intracranial bleeding events. Comparatively, of the 18,618 patients prescribed rivaroxaban, 595 had recurrent VTE and 577 had gastrointestinal or intracranial bleeding events. According to the study authors, these findings suggest that apixaban has superior effectiveness and safety compared with rivaroxaban and may provide guidance to clinicians and patients when selecting anticoagulant for treatment of VTE.

Media contacts For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the lead author, Ghadeer K. Dawwas, MSc, MBA, PhD, please contact Lauren Ingeno at Lauren.Ingeno@Pennmedicine.upenn.edu.

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