General Critical Care

This systematic review evaluated proton-pump inhibitors (PPIs) for stress ulcer prophylaxis in critically ill patients. Twelve trials with 9,533 patients were included. PPIs reduced clinically significant upper gastrointestinal bleeding (RR, 0.51; 95% CI, 0.34 to 0.76; high certainty). PPIs showed little to no effect on mortality (RR, 0.99; 95% CI, 0.93 to 1.05; low certainty). Subgroup analysis indicated possible reduced 90-day mortality in less severely ill patients (RR, 0.89; 95% CI, 0.80 to 0.98) but increased mortality in more severely ill patients (RR, 1.08; 95% CI, 0.96 to 1.20).

Proton-Pump Inhibitors to Prevent Gastrointestinal Bleeding — An Updated Meta-Analysis | NEJM Evidence

Atrial fibrillation (AF) is observed to be 15 times more common in patients with cirrhosis compared to the general population. Despite this high incidence, individuals with cirrhosis have been systematically excluded from randomized clinical trials evaluating anticoagulants in AF patients. To address this gap, researchers utilized two extensive U.S. insurance databases comprising nearly 25,000 patients with cirrhosis and new-onset nonvalvular AF. They conducted a propensity score–matched comparison between patients who began treatment with apixaban and those who initiated either rivaroxaban or warfarin.

The findings revealed that patients treated with apixaban had a significantly lower risk of major bleeding compared to those treated with rivaroxaban (5.1% vs. 8.7% annually) or warfarin (5.1% vs. 7.9% annually). There were no observed differences in the rates of ischemic embolic events (such as stroke) or all-cause mortality among the different oral anticoagulant groups.

This retrospective study, which emulates a randomized study design through the use…

RV dilation and TR associated with PE

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