Appropriate duration of dual antiplatelet therapy still unclear; Ebola preparedness following cluster of U.S. cases

1. Appropriate duration of dual antiplatelet therapy still unclear

A systematic review of published evidence does little to clarify the appropriate duration of dual antiplatelet therapy (DAPT) following drug eluting stent placement. The evidence suggests that longer duration therapy decreases the risk for myocardial infarction, but increases the risk for major bleeding events, and may provide a slight increase in mortality. The results are published in Annals of Internal Medicine.

DAPT with aspirin and a P2Y12 inhibitor is usually administered for 6-12 months after drug eluting stent placement to prevent stent thrombosis. The appropriate duration of therapy is controversial because of the increased risk for bleeding. Researchers reviewed 9 published studies of randomized-controlled trials to compare clinical outcomes with longer versus shorter duration DAPT following drug eluting stent placement in adults with coronary artery disease. The data suggest that extended DAPT protects against myocardial infarction but increases major bleeding events and, possibly, mortality. The authors suggest that therapy duration should be based on patient preferences following a discussion of the benefits and harms.

2. Contact tracing and monitoring exposes challenges of Ebola preparedness following cluster of U.S. cases

Actively monitoring and tracing contacts of a cluster of U.S. Ebola patients exposes the challenges associated with managing high-consequence communicable diseases, according to an article being published in Annals of Internal Medicine. Researchers suggest that planning for these challenges will strengthen collective preparedness for emerging diseases like Ebola and for resurgences of familiar diseases such as measles and tuberculosis.

Following the hospitalization and death of the first U.S.-diagnosed case of Ebola virus disease in September 2014, two health care workers who had cared for the patient were confirmed to have Ebola infections. Contact tracing methods were implemented to monitor those having personal or health care contact with the patient(s) for potential symptoms of Ebola virus. Researchers studied data on these contacts to assess implementation of contact tracing methods. They found that establishing accurate tracing and monitoring mechanisms was a particular challenge, as was data management. They suggest that preparedness activities include pre-designating a limited cadre of health care staff - including EMS and emergency room personnel - to interact with possible Ebola cases so that exposure is minimized. They also noted the challenge of large-scale application and enforcement of movement restrictions on a population. They suggest that humanitarian services be utilized to meet non-clinical needs and to protect the dignity and privacy of contacts under monitoring and quarantine.