This Week in JAMA

Antiplatelet thienopyridines such as clopidogrel are recommended to be discontinued 5 to 7 days before surgery to minimize bleeding risk. However, this strategy is associated with an increased risk of thrombosis. In a randomized placebo-controlled trial involving 210 patients receiving a thienopyridine and awaiting coronary artery bypass graft surgery, Angiolillo and colleagues evaluated the use of cangrelor—a reversible platelet inhibitor—as a bridge therapy from thienopyridine cessation until surgery. Platelet reactivity was assessed daily, and the authors found that compared with placebo, cangrelor was associated with a higher rate of maintenance of platelet inhibition.

Article AND AUTHOR VIDEO INTERVIEW

Methylxanthine (caffeine) is the respiratory stimulant of choice for the treatment of apnea of prematurity. In the Caffeine for Apnea of Prematurity trial, in which very low-birth-weight (VLBW) infants were randomly assigned to receive caffeine therapy or placebo, caffeine therapy was associated with lower rates of cerebral palsy and cognitive delay at 18 to 21 months of age. In a 5-year follow-up of 1640 (84.9%) of the study participants, Schmidt and colleagues found that among the children who survived to age 5 years, neonatal caffeine therapy was no longer associated with reduced rates of motor and cognitive impairment. In an editorial, Maitre and Stark discuss neuroprotection for premature infants and the importance of prospective long-term follow-up to assess the efficacy of new therapies.

ArticleArticle

Pediatric liver transplant recipients face a potential lifelong burden of immunosuppressive therapy, which is associated with a number of adverse effects. Preliminary data have suggested that some liver transplant recipients can maintain normal liver function without immunosuppression. In a multicenter and single-group pilot trial, Feng and colleagues assessed the feasibility of immunosuppression withdrawal in 20 pediatric recipients of parental living donor liver transplants who were stable while treated with single-drug immunosuppressive therapy. The authors report that 12 of the 20 children (60%) remained free of immunosuppression for at least 12 months (median, 35.7; interquartile range, 28.4-39.7 months) with normal graft function and stable allograft histology.

Article

In a systematic review and meta-analysis of data from 47 clinical trials and observational studies that involved 44 844 patients who underwent knee or hip arthroplasty and received recommended venous thromboembolism (VTE) prophylaxis, Januel and colleagues assessed the incidence of symptomatic, in-hospital venous thromboembolism (VTE). From their analyses, the authors estimate that using current VTE prophylaxis, approximately 1 in every 100 patients undergoing knee arthroplasty and 1 in every 200 patients undergoing hip arthroplasty will develop a symptomatic VTE before hospital discharge. In an editorial, Heit discusses the extended period of risk for VTE following hip and knee replacement surgery and the implications for patient safety and quality improvement.

ArticleArticle

Researchers are probing the mechanisms underlying pain and are working to develop novel approaches to pain treatment.

Article

Screening and treatment of dyslipidemia in children

Article AUTHOR AUDIO INTERVIEWArticle

Plain packaging of tobacco products in Australia

Article

“There are no federal standards defining what assisted living actually is, much less the quality of care such facilities should provide.” From “Lessons in Elder Care.”

Article

Join George A. Bray, MD, Wednesday, January 18, from 2 to 3 PM eastern time to discuss the effect of dietary protein content on weight. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

Ms K, a 14-year-old girl with a BMI of 40, experiences significant discord with her parents over food choices. How would you manage her clinical care? Go to www.jama.com to read the case. Submission deadline is January 29.

For your patients: Information about liver transplantation.

Article