Early Versus Late Administration of P2Y 12 Inhibitors in Non-ST Segment Elevation Myocardial Infarction and Delayed Cardiac Catheterization.

ABSTRACT: Regardless of early invasive or ischemia-guided approaches to non-ST segment elevation myocardial infarction (NSTEMI) management, P2Y 12 inhibitors remain the backbone in therapy. The ideal timing of administration remains unclear. The purpose of this study was to determine the safety and effectiveness of early versus late administration of P2Y 12 inhibitors in patients presenting with an NSTEMI who go to the catheterization laboratory beyond 24 hours from presentation. We performed a single center, retrospective cohort study. Patients were classified into groups depending on whether they received early versus late administration of a P2Y 12 inhibitor. The primary outcome was the rate of major and clinically relevant, nonmajor bleeding (CRNMB). Secondary outcomes included troponin peak and length of stay after cardiac catheterization. Of the 121 patients included, 53 patients were in the early and 68 patients were in the late group. The number of bleeding events were similar between both groups ( P = 1.00). There were 3 (5.7%) major bleeding events in the early group and 5 (7.4%) bleeding events in the late group. There were 5 (9.4%) CRNMB events in the early group and 6 (8.8%) CRNMB events in the late group. There was a significant difference in troponin peak, 4.56 ng/mL in the early group and 1.77 ng/mL in the late group ( P = 0.02). The rate of bleeding did not differ between patients who received early or late administration of P2Y 12 inhibitors for NSTEMI management who undergo delayed cardiac catheterization.

Systematic Review of Evening Primrose (Oenothera biennis) Preparations for the Facilitation of Parturition.

BACKGROUND: The objective of this systematic review was to characterize the efficacy and safety of evening primrose (EP) for facilitation of parturition in peripartum persons. METHODS: This search sought records related to the efficacy and safety of EP preparations to facilitate parturition. Eligibility criteria were primary literature with efficacy or safety outcomes reported; studied in peripartum persons; and available in English. Records were excluded if they were available as abstracts only. Data was synthesized by study characteristics, patient demographics, and outcomes. The RoB2 and ROBINS-I were used to assess risk of bias. RESULTS: A total of 11 studies met inclusion criteria: seven randomized placebo-controlled trials, one randomized non placebo-controlled trial, one case study, one observational retrospective study, and one quasi-experimental cross-sectional study. Efficacy outcomes included Bishop scores and duration of labor during the different phases. Reported adverse events were generally mild and included increased blood pressure, decreased heart rate, pain, bleeding, nausea, and vomiting. Important risks of bias exist across the literature reviewed. CONCLUSIONS: The use of EP for parturition in peripartum individuals is not recommended. Further research is warranted before use during parturition or the peripartum period. Other: The authors deny conflicts of interest. The study was neither registered nor funded.