0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
This Week in JAMA | January 18, 2012|

This Week in JAMA FREE

JAMA. 2012;307(3):223. doi:10.1001/jama.2011.2023.
Text Size: A A A
Published online

BRIDGING ANTIPLATELET THERAPY WITH CANGRELOR

Antiplatelet thienopyridines such as clopidogrel are recommended to be discontinued 5 to 7 days before surgery to minimize bleeding risk. However, this strategy is associated with an increased risk of thrombosis. In a randomized placebo-controlled trial involving 210 patients receiving a thienopyridine and awaiting coronary artery bypass graft surgery, Angiolillo and colleagues evaluated the use of cangrelor—a reversible platelet inhibitor—as a bridge therapy from thienopyridine cessation until surgery. Platelet reactivity was assessed daily, and the authors found that compared with placebo, cangrelor was associated with a higher rate of maintenance of platelet inhibition.

CAFFEINE FOR APNEA OF PREMATURITY: 5-YEAR FOLLOW-UP

Methylxanthine (caffeine) is the respiratory stimulant of choice for the treatment of apnea of prematurity. In the Caffeine for Apnea of Prematurity trial, in which very low-birth-weight (VLBW) infants were randomly assigned to receive caffeine therapy or placebo, caffeine therapy was associated with lower rates of cerebral palsy and cognitive delay at 18 to 21 months of age. In a 5-year follow-up of 1640 (84.9%) of the study participants, Schmidt and colleagues found that among the children who survived to age 5 years, neonatal caffeine therapy was no longer associated with reduced rates of motor and cognitive impairment. In an editorial, Maitre and Stark discuss neuroprotection for premature infants and the importance of prospective long-term follow-up to assess the efficacy of new therapies.

IMMUNOSUPPRESSION WITHDRAWAL, LIVER GRAFT FUNCTION

Pediatric liver transplant recipients face a potential lifelong burden of immunosuppressive therapy, which is associated with a number of adverse effects. Preliminary data have suggested that some liver transplant recipients can maintain normal liver function without immunosuppression. In a multicenter and single-group pilot trial, Feng and colleagues assessed the feasibility of immunosuppression withdrawal in 20 pediatric recipients of parental living donor liver transplants who were stable while treated with single-drug immunosuppressive therapy. The authors report that 12 of the 20 children (60%) remained free of immunosuppression for at least 12 months (median, 35.7; interquartile range, 28.4-39.7 months) with normal graft function and stable allograft histology.

CLINICIAN'S CORNER VTE AFTER ARTHROPLASTY WITH PROPHYLAXIS

In a systematic review and meta-analysis of data from 47 clinical trials and observational studies that involved 44 844 patients who underwent knee or hip arthroplasty and received recommended venous thromboembolism (VTE) prophylaxis, Januel and colleagues assessed the incidence of symptomatic, in-hospital venous thromboembolism (VTE). From their analyses, the authors estimate that using current VTE prophylaxis, approximately 1 in every 100 patients undergoing knee arthroplasty and 1 in every 200 patients undergoing hip arthroplasty will develop a symptomatic VTE before hospital discharge. In an editorial, Heit discusses the extended period of risk for VTE following hip and knee replacement surgery and the implications for patient safety and quality improvement.

MEDICAL NEWS & PERSPECTIVES

Researchers are probing the mechanisms underlying pain and are working to develop novel approaches to pain treatment.

VIEWPOINTS

Screening and treatment of dyslipidemia in children

Plain packaging of tobacco products in Australia

A PIECE OF MY MIND

“There are no federal standards defining what assisted living actually is, much less the quality of care such facilities should provide.” From “Lessons in Elder Care.”

AUTHOR IN THE ROOM TELECONFERENCE

Join George A. Bray, MD, Wednesday, January 18, from 2 to 3 PM eastern time to discuss the effect of dietary protein content on weight. To register, go to http://www.ihi.org/AuthorintheRoom.

EDITOR'S AUDIO SUMMARY

Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

READERS RESPOND

Ms K, a 14-year-old girl with a BMI of 40, experiences significant discord with her parents over food choices. How would you manage her clinical care? Go to www.jama.com to read the case. Submission deadline is January 29.

JAMA PATIENT PAGE

For your patients: Information about liver transplantation.

First Page Preview

View Large
First page PDF preview

Tables

References

Letters

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.