The 2019 American Heart Association/American Stroke Association guideline update provides evidence-based recommendations for the early management of acute ischemic stroke, building upon and revising the 2018 guideline. While the document addresses a broad range of diagnostic and therapeutic issues, it also highlights the management of orolingual angioedema, a recognized complication of intravenous alteplase, particularly in patients concurrently taking angiotensin-converting enzyme inhibitors. The guideline emphasizes airway protection as the foremost priority, recommending endotracheal intubation if swelling involves the larynx, palate, or oropharynx, especially in the setting of rapid progression. For milder cases limited to the anterior tongue or lips, close observation may be appropriate. Alteplase infusion should be discontinued, and angiotensin-converting enzyme inhibitors withheld. Pharmacologic management includes intravenous methylprednisolone, diphenhydramine, and an H2 re...

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A 2023 narrative review meticulously evaluated the efficacy, pharmacokinetics, and safety of sugammadex in reversing rocuronium-induced neuromuscular blockade (NMB) in patients with end-stage renal disease (ESRD). Prospective trials demonstrated that sugammadex at 2 mg/kg effectively reversed moderate NMB in ESRD patients without significant adverse events, although with a modestly prolonged recovery time compared to healthy controls. Similarly, a 2015 clinical trial reported that sugammadex at 4 mg/kg successfully reversed deep NMB, with a recovery time of 5.6 minutes in ESRD patients, slower than the 2.7 minutes observed in controls, but with no indications of residual NMB or recurrence. Pharmacokinetic investigations, including a 2010 study that revealed markedly reduced clearance of sugammadex in ESRD patients, resulting in prolonged systemic exposure. Despite the stable sugammadex–rocuronium complex formation being theorized to minimize the risk of recurarization, the long-term...

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A 2018 review article conducted by the European Society of Cardiology aimed to determine if modified antithrombotic management was necessary for patients with different measurements of body weight. Based on the available evidence, there was no evidence to support for adjusting the dosing of cangrelor based on weight, whether it be ideal or adjusted body weight, for patients who were either overweight or underweight. Currently, there were no studies suggesting the need for any weight-based adjustments (ideal or adjusted) beyond the standard dosing based on body weight. However, in cases where patients were classified as overweight or underweight, clinical decision-making should be employed to ensure careful dosing in order to prevent over-or underdosing, respectively. [1] A 2020 retrospective review focused on the utilization of cangrelor in patients receiving mechanical circulatory support (MCS), aiming to analyze the complications and outcomes associated with its use during MCS...

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According to recent guidance provided by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), measles treatment is primarily supportive. To help reduce the risk of complications, the WHO recommends that all children and adults with acute measles receive two doses of vitamin A, administered 24 hours apart. The recommended oral dosing is based on age: infants younger than 6 months should receive 50,000 IU once daily for 2 days; those 6 to 11 months old should receive 100,000 IU once daily for 2 days; and children 12 months and older should receive 200,000 IU once daily for 2 days. For children showing clinical signs or symptoms of vitamin A deficiency, a third age-appropriate dose should be administered 2 to 4 weeks after the initial treatment. In general, the guidance notes that measuring vitamin A levels is typically not necessary. No other recommendations specific to adults are noted. [1,2] Much of the other literature for treatment of m...

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A recently published 2025 meta-analysis included 11 trials involving 85,373 participants to evaluate the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs). The analysis found the risk of acute pancreatitis to not be significantly increased with the use of GLP-1RAs compared to placebo (hazard ratio [HR] 1.02; 95% confidence interval [CI] 0.78 to 1.33). Overall, there was no difference in the risk of serious adverse events, including acute pancreatitis and severe hypoglycemia, between GLP-1RAs and placebo (risk ratio [RR] 0.95; 95% CI 0.90 to 1.01). However, it should be noted that treatment discontinuation due to adverse events occurred more frequently with GLP-1RAs compared to placebo (RR 1.51; 95% CI 1.18 to 1.94). [1] Another meta-analysis published in 2024 evaluated the safety and efficacy of GLP-1RAs on cardiovascular events in overweight or obese non-diabetic patients. A total of 10 randomized controlled trials, comprising 29,325 patients, were included for ana...

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