DOACs don’t drive epistaxis admissions

Epistaxis-related ED presentations have risen in line with the with increasing use of DOACS but outcomes have improved since the era of warfarin and antiplatelets, according to researchers at Flinders Medical Centre.

A retrospective case-control study investigated the change in the number of patients admitted with epistaxis through the hospitals ED since 2013. It found a small and non-significant increase in admissions in 2018 compared  to the same period for 2013, likely reflecting wider use of anticoagulants in general.

The proportion of patients admitted with epistaxis while taking an anticoagulant or antiplatelet agent increased from 66% in 2013 to 93% in 2018.  While one third of patients (36%) admitted in 2018 were taking DOACs, the length of stay was two times shorter (mean ratio = 2.08 days) compared to 2013.

There was no difference in the proportion of patients requiring haemostatic measures such as surgery or in readmission rates between the two time periods

The researchers said most patients taking DOACS who had epistaxis could be managed successfully with intranasal packing and cautery alone.

The findings are published in the American Journal of Otolaryngology.

Anakinra may prevent intestinal injury in blood cancer patients

South Australian researchers are repurposing the arthritis drug anakinra to try prevent the intestinal mucosal barrier injury that leads to infections and fever in patients receiving blood cancer therapies.

A team at the Supportive Oncology Research Group at the South Australian Health and Medical Research Institute (SAHMRI), Adelaide, says the interleukin (IL-1) receptor antagonist may have a role in reducing antibiotic use in haematology patients in whom chemotherapy causes intestinal inflammation and subsequent breakdown of the mucosal barrier, permitting translocation of enteric pathogens.

In animal studies they showed that mucosal barrier injury induced by the mucotoxic chemotherapeutic agent, high-dose melphalan (HDM) was characterized by hyper-active IL-1b/CXCL1/neutrophil signalling. Inhibition of this pathway with anakinra minimised the duration and intensity of mucosal barrier injury and accompanying clinical symptoms, including diarrhoea, weight loss and fever.

Co-author and consultant haematologist Professor Nicole Blijlevens, said a greater understanding of where infections originated led to finding alternative solutions to controlling bacteria.

“While we used to think infections predominantly came from external sources like hospital surfaces and equipment, we now know that they mainly come from inside the person’s gut,” she said.

“This has refocused our attention to how we can prevent these bacteria from moving from the gut to the blood.

“We showed that this drug – which is usually used to control rheumatoid arthritis – was not associated with any adverse events in people undergoing high dose chemotherapy.

“For decades, we have relied on antibiotics to prevent infection, but this new work suggests there may be alternatives to minimise our reliance on antibiotics.

Their study has been published in Scientific Reports .

Medical acronyms mystify patients

As more patients are accessing their electronic medical records, many fail to comprehend basic medical abbreviations and acronyms, a study has found.

Comprehension of common abbreviations such as ‘HTN’ (hypertension) and ‘MI’ (myocardial infarction) remained below 40%, much lower than clinicians estimated, a survey conducted at three US hospitals found.

The survey of 60 patients found that most understood terms such as hrs (hours) and BP (blood pressure) but only two thirds knew what ED meant and as few as 20% comprehended terms such as hx (history) and HF (heart failure).

Researchers at the Department of Biomedical Informatics, Columbia University, New York, said clinicians should not assume that patients will understand even the most basic medical abbreviations. Automated text programs that convert and spell out acronyms in notes may help overcome misunderstanding of some medical abbreviations, they suggested.

The findings are published in JAMA Network Open.