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Scholarly Works (2 results)

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Symposium 2024 (2024)

OBJECTIVE An order set was created to optimize the time to administration and ensure proper dosing of benzodiazepine and anti-seizure medications in patients with status epilepticus (SE).

BACKGROUND The Neurocritical Care Society and American Academy of Neurology have developed expert consensus guidelines and quality measures on management of acute SE which recommend that upon seizure onset, benzodiazepines and anti-seizure medications should be administered rapidly (within 5 and 10 minutes, respectively per NCS guidelines) with appropriate weight- based dosing.

DESIGN/METHODS A SE order set was designed in an electronic health record which included pre-determined loading dosages of anti-seizure medications and benzodiazepines in accordance with current guidelines. Education regarding status epilepticus and order set was given to emergency medicine, neurology, neurosurgery, and neurocritical care divisions prior to order set availability in July 2023. We tracked use of the order set in all patients with the diagnosis of SE from July 1, 2023 to October 10, 2023. Our goal was to track the proportion of patients who received benzodiazepines within 5 minutes and anti-seizure medication within 10 minutes of seizure detection, and appropriate first dose of benzodiazepine and anti-seizure medication, before and after order set implementation.

RESULTS The recommended loading dose was used 100% of the time (8/8) with order set use compared to 18% (8/44) without the order set. Recommended benzodiazepine dose was used 50% of the time (2/4) with the order set compared to 64% (28/44) without. Average time to anti-seizure medication administration with the order set was 33 minutes compared to 61 minutes without. Average time to benzodiazepine medication administration was 5 minutes with order set use compared to 9 minutes without.

CONCLUSIONS Our initiative shows there can be improvement in adherence to status epilepticus guideline execution in dosage and time to administration of benzodiazepines and anti-seizure medications with implementation of a standardized SE order set.

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UC Davis Previously Published Works (2021)
To analyze the efficacy and safety of activated prothrombin complex concentrates (aPCC) and four-factor prothrombin complex concentrates (4F-PCC) to prevent hematoma expansion in patients taking apixaban or rivaroxaban with intracranial hemorrhage (ICH). In this multicenter, retrospective study, sixty-seven ICH patients who received aPCC or 4F-PCC for known use of apixaban or rivaroxaban between February 2014 and September 2018 were included. The primary outcome was the percentage of patients who achieved excellent/good or poor hemostasis after administration of aPCC or 4F-PCC. Secondary outcomes included hospital mortality, thromboembolic events during admission, and transfusion requirements. Excellent/good hemostasis was achieved in 87% of aPCC patients, 89% of low-dose 4F-PCC [< 30 units per kilogram (kg)], and 89% of high-dose 4F-PCC (≥ 30 units per kg). There were no significant differences in excellent/good or poor hemostatic efficacy (p = 0.362). No differences were identified in transfusions 6 h prior (p = 0.087) or 12 h after (p = 0.178) the reversal agent. Mortality occurred in five patients, with no differences among the groups (p = 0.838). There were no inpatient thromboembolic events. Both aPCC and 4F-PCC appear safe and equally associated with hematoma stability in patients taking apixaban or rivaroxaban who present with ICH. Prospective studies are needed to identify a superior reversal agent when comparing andexanet alfa to hospital standard of care (4F-PCC or aPCC) and to further explore the optimal dosing strategy for patients with ICH associated with apixaban or rivaroxaban use.
    Cover page: Treatment of adults with intracranial hemorrhage on apixaban or rivaroxaban with prothrombin complex concentrate products
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