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3. Eltrombopag before procedures in patients with cirrhosis and thrombocytopenia

Author

Afdhal NH, Giannini EG, Tayyab G, Mohsin A, Lee JW, Andriulli A, Jeffers L, McHutchison J, Chen PJ, Han KH, Campbell F, Hyde D, Brainsky A, Theodore D, ELEVATE Study Group […, Akram J, Bessonova E, Bilodeau M, Bloomer J, Botta Fridlund D, Bzowej N, Calmus Y, Carbonell N, Caro Patón A, Cholewinska G, Chuang WL, Colombato L, Colombo M, Craxi A, Di Leo A, Diago M, Dumortier J, Elkasahab M, Everson G, Fallon M, Fedeli G, Finazzi R, Fontanella A, Francavilla A, Gadano A, Gambarin Gelwan M, Gordon F, Graus Morales J, Grieco A, Gugenheim J, Homenda W, Iaquinto G, Kang H, Khan Z, Kuliczkowski K, Kwo P, Lee JH, Lee W, Lee YS, Mazur W, Moreno C, Morozov V, Muñoz A, Navasa Anadón M, Nijhawan S, Pinzello G, Poordad F, Prieto Castillo M, Rafalsky V, Rapaccini G, Regenstein F, Rewak W, Riley T, Ripoll Noiseux C, Rizzetto M, Rodrigo Lopez J, Russo M, Samuel D, Sánchez Antolín G, Satyanaryana R, Savarino V, Shiffman M, Sigal S, Solá Lamoglia R, Sterling R, Tanno H, Te H, Terg R, Thuluvath P, Trepo C, Vargas H, Xiol Quingles X, Zaman A, Fontana R, Kim K, Abrams C, Gish R, Cardenas A, ANDREONE, PIETRO, MAZZELLA, GIUSEPPE, Afdhal, NH, Giannini, EG, Tayyab, G, Mohsin, A, Lee, JW, Andriulli, A, Jeffers, L, McHutchison, J, Chen, PJ, Han, KH, Campbell, F, Hyde, D, Brainsky, A, Theodore, D, Craxi, A, Afdhal NH, Giannini EG, Tayyab G, Mohsin A, Lee JW, Andriulli A, Jeffers L, McHutchison J, Chen PJ, Han KH, Campbell F, Hyde D, Brainsky A, Theodore D, ELEVATE Study Group […, Akram J, Andreone P, Bessonova E, Bilodeau M, Bloomer J, Botta-Fridlund D, Bzowej N, Calmus Y, Carbonell N, Caro Patón A, Cholewinska G, Chuang WL, Colombato L, Colombo M, Craxi A, Di Leo A, Diago M, Dumortier J, Elkasahab M, Everson G, Fallon M, Fedeli G, Finazzi R, Fontanella A, Francavilla A, Gadano A, Gambarin-Gelwan M, Gordon F, Graus Morales J, Grieco A, Gugenheim J, Homenda W, Iaquinto G, Kang H, Khan Z, Kuliczkowski K, Kwo P, Lee JH, Lee W, Lee YS, Mazur W, Mazzella G, Moreno C, Morozov V, Muñoz A, Navasa Anadón M, Nijhawan S, Pinzello G, Poordad F, Prieto Castillo M, Rafalsky V, Rapaccini G, Regenstein F, Rewak W, Riley T, Ripoll Noiseux C, Rizzetto M, Rodrigo Lopez J, Russo M, Samuel D, Sánchez Antolín G, Satyanaryana R, Savarino V, Shiffman M, Sigal S, Solá Lamoglia R, Sterling R, Tanno H, Te H, Terg R, Thuluvath P, Trepo C, Vargas H, Xiol Quingles X, Zaman A, Fontana R, Kim K, Abrams C, Gish R, Cardenas A, and …]

Subjects
Liver Cirrhosis, Male, Cirrhosis, Chronic liver disease, Benzoates, law.invention, chemistry.chemical_compound, Randomized controlled trial, law, Receptors, Clinical endpoint, 80 and over, Medicine, CIRRHOSIS, Aged, 80 and over, Benzoic Acids, General Medicine, CHRONIC LIVER DISEASE, Middle Aged, Hydrazines, Thrombopoietin, Elective Surgical Procedures, Anesthesia, Female, Elective Surgical Procedure, Receptors, Thrombopoietin, Adult, Adolescent, Eltrombopag, ELTROMBOPAG, Hemorrhage, Platelet Transfusion, Placebo, Young Adult, Double-Blind Method, Elective, Surgical Procedures, Elective, Humans, Aged, THROMBOCYTOPENIA, Surgical Procedures, business.industry, Platelet Count, cirrhosis, Settore MED/09 - MEDICINA INTERNA, medicine.disease, Thrombocytopenia, Platelet transfusion, chemistry, Chronic Disease, Pyrazoles, business
Abstract

Eltrombopag is an oral thrombopoietin-receptor agonist. This study evaluated the efficacy of eltrombopag for increasing platelet counts and reducing the need for platelet transfusions in patients with thrombocytopenia and chronic liver disease who are undergoing an elective invasive procedure.We randomly assigned 292 patients with chronic liver disease of diverse causes and platelet counts of less than 50,000 per cubic millimeter to receive eltrombopag, at a dose of 75 mg daily, or placebo for 14 days before a planned elective invasive procedure that was performed within 5 days after the last dose. The primary end point was the avoidance of a platelet transfusion before, during, and up to 7 days after the procedure. A key secondary end point was the occurrence of bleeding (World Health Organization [WHO] grade 2 or higher) during this period.A platelet transfusion was avoided in 104 of 145 patients who received eltrombopag (72%) and in 28 of 147 who received placebo (19%) (P0.001). No significant difference between the eltrombopag and placebo groups was observed in bleeding episodes of WHO grade 2 or higher, which were reported in 17% and 23% of patients, respectively. Thrombotic events of the portal venous system were observed in 6 patients who received eltrombopag, as compared with 1 who received placebo, resulting in the early termination of the study. The incidence and severity of other adverse events were similar in the eltrombopag and placebo groups.Eltrombopag reduced the need for platelet transfusions in patients with chronic liver disease who were undergoing elective invasive procedures, but it was associated with an increased incidence of portal-vein thrombosis, as compared with placebo. (Funded by GlaxoSmithKline; ELEVATE ClinicalTrials.gov number, NCT00678587.).

Published
2012

4. [Prospective analysis of central venous catheter colonization and related factors].

Author

Pérez Castro I, Iborra Obiols MI, Comas Munar MD, Yrurzun Andreu R, Sanz Moncusí M, Lahoz Simón C, Gómez Montoya MI, Comallonga Bartomeu T, and Navasa Anadón M

Subjects
Female, Hospitals, Humans, Male, Middle Aged, Prospective Studies, Bacteria isolation & purification, Catheterization, Central Venous, Equipment Contamination statistics & numerical data
Abstract

Objective: To evaluate the incidence of central venous catheter (CVC) colonization in inpatient units of the Institut de Malalties Digestives i Metabòliques (IMDiM) of Hospital Clinic (Barcelona, Spain) with a view to reducing the risk of infection., Method: A 4-month descriptive, prospective and longitudinal study was performed. A total of 230 patients admitted to the IMDiM with CVC were included during the study period. At catheter removal, the tip was cultured and, if the patient had fever, two blood cultures were also obtained. A database was created. Data were analyzed using SPSS v.11.0. Variables were compared with the Chi-square and Student's t-tests and a multivariate analysis was performed using Cox logistic regression. A value of P<0.05 was considered significant., Results: Catheter tip culture was positive in 45.2%. The rate of catheter-related bloodstream infections was 2.9 per thousand catheter-days, which was clinically significant. The probability of catheter tip contamination 10 days after placement was 25%. Multivariate analysis revealed that the independent variables associated with a higher risk of infection were catheter type, changes of dressing, and infected bacterial stopcocks., Conclusions: These results suggest that: 1) the protocol for catheter insertion and care should be reviewed and updated, 2) catheter removal should be considered after the 10th day, 3) the appropriate type of catheter should be selected, the catheter with the lowest number of lumens should be used, and changes of catheter dressing should be reduced.

Published
2009
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