Idarucizumab for Dabigatran Reversal Pollack, Charles V; Reilly, Paul A; Eikelboom, John ...
The New England journal of medicine,
08/2015, Letnik:
373, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Intravenous idarucizumab, an antibody fragment of a human antibody specific for dabigatran, produced rapid reversal of the anticoagulant effect in patients with bleeding or an urgent surgical ...indication with no apparent toxic effects or rebound hypercoagulable state.
A non–vitamin K antagonist oral anticoagulant, dabigatran etexilate (dabigatran) is an oral thrombin inhibitor that is licensed for the prevention of stroke in patients with nonvalvular atrial fibrillation and for the prevention and treatment of venous thromboembolism. Although dabigatran is associated with less serious bleeding than warfarin,
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life-threatening bleeding can occur; in addition, dabigatran-treated patients may require urgent surgery or intervention, and dabigatran can increase the risk of perioperative bleeding. To improve the treatment of such patients, a specific dabigatran-reversal agent would be beneficial.
Idarucizumab, a monoclonal antibody fragment, binds dabigatran with an affinity that is 350 times as . . .
Idarucizumab was 100% effective in reversing the anticoagulant effect of dabigatran among 300 patients with uncontrolled bleeding (median time to bleeding cessation, 2.5 hours) and among 200 patients ...who required an urgent procedure (median time to procedure initiation, 1.6 hours).
Summary
Idarucizumab, a Fab fragment directed against dabigatran, produced rapid and complete reversal of the anticoagulation effect of dabigatran in animals and in healthy volunteers. The Study of ...the
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abigatran (RE-VERSE AD™) is a global phase 3 prospective cohort study aimed at investigating idarucizumab in dabigatran-treated patients who present with uncontrollable or life-threatening bleeding, and in those requiring urgent surgery or intervention. We describe the rationale for, and design of the trial (clinicaltrials.gov NCT02104947).
Limited studies exist on women’s mild traumatic brain injury received from episode of intimate partner violence. This study aims to identify the occurrence of intimate partner violence‐related mild ...traumatic brain injury in Chinese women admitted to emergency units; and examine the physical, mental, and cognitive functioning of abused women with mild traumatic brain injury related to violent episodes. Eighty‐six Chinese abused women presenting at emergency units in four major local hospitals in Hong Kong between January 2014 and December 2016 were recruited. They were admitted for the treatment of intimate partner violence‐related physical injuries and were screened for traumatic brain injury by the emergency unit nurses at triage. Participants were assessed for traumatic brain injury based on the definition from US Center for Disease Control and Prevention, post‐concussion physical symptoms, anxiety and depression, health‐related quality of life, and cognitive functioning. Structured multiphase regression was used to examine the impact of intimate partner violence‐related mild traumatic brain injury on physical, mental, and cognitive functioning of participants. We found that 24.4% of participants had intimate partner violence‐related mild traumatic brain injury. There were significantly more severe post‐concussion physical symptoms in abused women with intimate partner violence‐related mild traumatic brain injury than those without mild traumatic brain injury (estimate = 18.7, 95% CI = 10.9 to 26.6, p < 0.001). The Mental Component Summary was also significantly associated with intimate partner violence‐related mild traumatic brain injury (estimate = ‐7.9, 95% CI = ‐13.8 to ‐2.1, p = 0.009). Regarding cognitive functioning, the mean total test scores indicated that both groups were cognitively abnormal and there was no significant impact from mild traumatic brain injury. This study provides evidence on the impact of mild traumatic brain injury and implications in screening for mild traumatic brain injury and early intervention for improving quality of life in abused women.
Intimate partner violence (IPV) is largely recognized to have a cyclical pattern and violence escalation in terms of frequency and intensity over time. However, there is a lack of systematic ...investigation of the profiles of victims and quantification of the patterns of injury of the victims associated with the first time versus repeated violence episodes. This study aimed to fill this knowledge gap by medical chart review of 878 victims in a 5-year period from 2010 to 2014 in Accident and Emergency Department (AED) of two public general hospitals in Hong Kong. The differences in injury patterns between the first IPV episode (FE) and recurrent IPV episodes (REs) experienced by male and female victims in heterosexual relationship were evaluated. The results indicated the violence escalation occurred in recurrent IPV in both genders. In female victims, there was significant increase in the number of injury locations (mean M = 2.0 vs. 2.2, p < .05), number of causes of injury (M = 1.7 vs. 2.2, p < .001) and police escort (15.2% vs. 22.1%, p < .05) in RE compared to FE. In male victims, however, only the increase in the number of causes of injury was significant (M = 1.6 vs. 2.1, p < .05) in RE compared to FE. In summary, our results highlight the escalation in the severity of harm of IPV victims in heterosexual relationship, and the gender differences in severity aggression and injury and help-seeking behavior change in recurrent IPV. Preventive measures are indicated to intervene the IPV occurrence and recurrence with rising morbidity and a potential of mortality.
Cohabitation, referring to a co-residential romantic relationship between two intimate partners without a marriage license, has become widely accepted in contemporary societies. It has been found ...that cohabitating women have a higher risk of experiencing intimate partner violence (IPV) than married women. However, as yet, no studies have investigated the level and pattern of IPV-associated physical injuries and its mental health impact on cohabitating women. Therefore, we aim to compare IPV-associated physical injuries between cohabitating and married women by conducting a review of 5-year medical records from the emergency departments of two major public hospitals in Hong Kong.
This is a retrospective cohort study. Using two computerized systems, we identified the medical charts of 1011 women who had experienced IPV and presented at emergency departments between 2010 and 2014, of which, 132 were cohabitating and 833 were married.
Cohabitating women were significantly younger (p-value < .0001) and had obtained a higher educational level (p-value = .008) than married women. After adjusting for those two variables, the logistic regression models showed that cohabitating women were approximately 2.1 times more likely than married women to present with head, neck, or facial injuries (OR = 2.1, 95% CI = 1.30-3.40, p = .002), and the risk of having multiple injuries in different locations (head, neck, face, torso, limbs) was almost twice that for cohabitating women compared with married women (OR = 1.82, 95% CI = 1.25-2.65, p = .001). Furthermore, cohabitating women were almost two times as likely as married women to experience more than one method of physical violence (OR = 1.72, 95% CI = 1.18-2.51, p = .005). There were no significant differences regarding mental health, police reporting, and discharge plans.
Owing to recent social changes to the family structure, including the growing acceptance of cohabitation, it is essential that a screening program for IPV is established for cohabitating women, as well as the inclusion of IPV content in medical and nursing curriculums and in-service training.
Healthcare services constitute the first formal support that many intimate partner violence (IPV) victims receive and a link to formal welfare and psychological support. The help-seeking behavior for ...psychosocial support, e.g., Accident and Emergency Departments (AED) onsite counseling, is key to developing effective support for IPV victims. This study aimed to strengthen the health-welfare support link to aid IPV prevention in AEDs by investigating the acceptance and refusal of on-site counseling by IPV victims. A retrospective cohort study retrieved and reviewed all records of IPV victims presenting at the AEDs of two Hong Kong hospitals between 2010 and 2014. A total of 157 male and 823 female IPV victims were identified, 295 of whom refused on-site counseling. Bivariate and multivariate analyses were performed to examine the association between help-seeking and demographic and violent injury-related factors. The odds of help-seeking via on-site counseling were significantly lower for victims with mental illness (aOR=0.49; 95% CI=0.27, 0.88). After controlling for all demographic characteristics, mental illness, and drug abuse information, sex remained an independent predictor of help-seeking (aOR=2.62; 95% CI=1.45, 4.74); victims who had experienced >2 abuse incidents were more likely to seek help than those who had experienced ≤2 abuse incidents (aOR=1.90; 95% CI=1.11, 3.26). The factors associated with help-seeking from on-site services by IPV victims reflect the need for multidisciplinary collaborative work aimed at IPV prevention. Healthcare professionals require training on how to promote help-seeking behavior targeted specifically for male and female IPV victims according to their needs and preferences.
•We investigated IPV's victims' acceptance for on-site counseling in AEDs.•Sex is an independent predictor of service acceptance.•The number of abuse episodes predicts IPV victims' help-seeking behaviors.•Multidisciplinary collaborative work is needed for IPV prevention.•Training on the sex differences in IPV victims' service acceptance is recommended.
Abstract Background Few studies have focused on the characteristics of male victims of intimate partner violence (IPV). Providers of care lack knowledge on the pathognomonic features to identify male ...IPV victims, who tend to be hidden. Objectives This study investigated the injury patterns of male IPV victims and their help-seeking characteristics. Methods A retrospective cohort study was carried out in two regional hospitals in Hong Kong. Data were collected from the hospital computer databases (i.e., the Accident & Emergency Information System and the Clinical Data Analysis and Reporting System) and the medical charts completed by physicians. Results Medical records were retrieved from August 1, 2009 to December 31, 2011 for all IPV victims presenting at the accident and emergency departments. There were 372 cases in total, including 54 male and 318 female cases. Male victims were more likely to have abrasions/scrapes (66.7%), human bites (20.4%), and laceration/cutting (18.5%) than female victims (31.4%, 1.3%, 6.9%; p < 0.001, p < 0.01, p < 0.001, respectively). More male victims received dressing (38.9%) and injection (13.0%) than female victims (14.5%, 3.5%; p < 0.001, p < 0.01, respectively). Fewer male victims attended consultation by the medical social worker (MSW; 5.6%) than female victims (21.7%). Conclusion Abrasion wounds are the most common in male victims of IPV. Male victims have lower rates of seeking help from MSWs, and most are aged 40 years or above. This study has identified important characteristics of male victims to aid the development of a comprehensive program for early IPV detection and management.
Quantification of injury burden is vital for injury prevention, as it provides a guide for setting policies and priorities. This study generated a set of Hong Kong specific disability weights (DWs) ...derived from patient experiences and hospital records. Patients were recruited from the Accident and Emergency Department (AED) of three major trauma centers in Hong Kong between September 2014 and December 2015 and subsequently interviewed with a focus on health-related quality of life at most three times over a 12-month period. These patient-reported data were then used for estimation of DWs. The burden of injury was determined using the mortality and inpatient data from 2001 to 2012 and then compared with those reported in the UK Burden of Injury (UKBOI) and global burden of diseases (GBD) studies. There were 22,856 mortality cases and 817,953 morbidity cases caused by injuries, in total contributing to 1,027,641 disability-adjusted life years (DALYs) in the 12-year study timeframe. Estimates for DALYs per 100,000 in Hong Kong amounted to 1192, compared with 2924 in UKBOI and 3459 in GBD. Our findings support the use of multiple data sources including patient-reported data and hospital records for estimation of injury burden.
Purpose
The mortality rate in patients with haemodynamically unstable pelvic fractures is as high as 40–60%. Despite the new advances in trauma care which are in phase in trauma centres in Hong Kong, ...the management of haemodynamically unstable pelvic fracture is still heterogeneous. The aim of this study is to review the results of management of haemodynamically unstable pelvic fracture patients in Hong Kong over a five year period.
Methods
This is a retrospective multi-centred cohort study of patients with haemodynamic and mechanically unstable pelvic fractures from 1 January 2010 to 31 December 2014. The primary outcome investigated is mortality of patients (including overall, 30-day, 7-day and 24-hour mortalities).
Results
Implementation of three-in-one pelvic damage control protocol was identified to be a significant independent predictive factor for overall, 30-day, seven-day and 24-hour mortalities. The overall in-hospital and 30-day mortality rates for patients managed with three-in-one protocol was 12.5%, while it was 11% for seven day mortality and 6% for 24 hour mortality. There were no significant differences in demographic characteristics, physiological measurements, types of pelvic fracture, severity and mechanism of injury between patients managed with or without three-in-one protocol.
Conclusions
Implementation of the multidisciplinary three-in-one pelvic damage control protocol reduces mortality and therefore should be highly recommended. The results are convincing as it has eliminated the limitations of our previous single-centred trial.
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