Comparative hemostatic efficacy of 4F-PCC in patients with intracranial hemorrhage on factor Xa inhibitors versus warfarin.

OBJECTIVE: Patients experiencing an intracranial hemorrhage (ICH) on oral anticoagulants often require rapid reversal. This study evaluated patients taking factor Xa inhibitors or warfarin that received reversal with 4-factor prothrombin complex concentrate (4F-PCC) for an ICH. The objective of the study was to determine if the efficacy of 4F-PCC for the reversal of factor Xa inhibitors is noninferior to its use in warfarin reversal in patients with ICH. METHODS: This was a retrospective, single center, noninferiority trial. Patients presenting to the emergency department with ICH were divided into two cohorts: those taking factor Xa inhibitors versus those taking warfarin. In each cohort, patients received anticoagulation reversal with weight-based 4F-PCC. The primary endpoint was hemostatic efficacy defined as ≤20% expansion in hematoma volume on repeat computed tomography imaging. A pre-specified noninferiority margin of -10% was selected to evaluate the difference between groups for the primary endpoint. RESULTS: A total of 221 patients were included in the study (factor Xa inhibitors, n = 87; warfarin, n = 134). Effective hemostasis was achieved in 70 patients (81%) on factor Xa inhibitors compared to 111 patients (83%) on warfarin, (-2.4% difference, [95% confidence interval, -12.87 to 8.12]; p = 0.654). There was no statistically significant difference between groups with regards to the primary outcome; however, the use of 4F-PCC in factor Xa inhibitor reversal was not noninferior when compared to 4F-PCC use for warfarin reversal. Hospital length of stay and discharge disposition were similar between cohorts. CONCLUSIONS: The efficacy of 4F-PCC in reversing factor Xa inhibitor-related ICH compared to warfarin-related ICH was not significantly different between groups; however, these results did not prove noninferiority. Further study is warranted to delineate 4F-PCC's role in reversing factor Xa inhibitors in patients with ICH.

Physiological costs of undocumented human migration across the southern United States border.

Political, economic, and climatic upheaval can result in mass human migration across extreme terrain in search of more humane living conditions, exposing migrants to environments that challenge human tolerance. An empirical understanding of the biological stresses associated with these migrations will play a key role in the development of social, political, and medical strategies for alleviating adverse effects and risk of death. We model physiological stress associated with undocumented migration across a commonly traversed section of the southern border of the United States and find that locations of migrant death are disproportionately clustered within regions of greatest predicted physiological stress (evaporative water loss). Minimum values of estimated evaporative water loss were sufficient to cause severe dehydration and associated proximate causes of mortality. Integration of future climate predictions into models increased predicted physiological costs of migration by up to 34.1% over the next 30 years.

Animal scavenging and scattering and the implications for documenting the deaths of undocumented border crossers in the Sonoran Desert.

Since 1998, over 5500 people have died while attempting to cross the U.S.-Mexico border without authorization. These deaths have primarily occurred in the Arizona desert. Despite the high volume of deaths, little experimental work has been conducted on Sonoran Desert taphonomy. In this study, pig carcasses were used as proxies for human remains and placed in different depositional contexts (i.e., direct sunlight and shade) that replicate typical sites of migrant death. Decomposition was documented through daily site visits, motion-sensitive cameras and GIS mapping, while skeletal preservation was investigated through the collection of the remains and subsequent faunal analysis. Our results suggest that vultures and domestic dogs are underappreciated members of the Sonoran scavenging guild and may disperse skeletal remains and migrant possessions over 25 m from the site of death. The impact of scavengers and the desert environment on the decomposition process has significant implications for estimating death rates and identifying human remains along the Arizona/Mexico border.