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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Practice Changing UpDates

Practice Changing UpDates
Authors:
April F Eichler, MD, MPH
Sadhna R Vora, MD
Literature review current through: Sep 2022. | This topic last updated: Oct 19, 2022.

INTRODUCTION — This section highlights selected specific new recommendations and/or updates that we anticipate may change usual clinical practice. Practice Changing UpDates focus on changes that may have significant and broad impact on practice, and therefore do not represent all updates that affect practice. These Practice Changing UpDates, reflecting important changes to UpToDate over the past year, are presented chronologically, and are discussed in greater detail in the identified topic reviews.

INFECTIOUS DISEASES (September 2022, Modified October 2022)

Booster doses with the bivalent COVID-19 mRNA vaccines

For individuals ≥5 years old who have received a primary COVID-19 vaccine series, we recommend a booster dose with a bivalent mRNA vaccine (Grade 1B). For individuals ≥5 years old who have received a primary COVID-19 vaccine series as well as booster doses with a monovalent vaccine, we suggest a booster dose with a bivalent mRNA vaccine (Grade 2C).

Booster doses of COVID-19 vaccines are a strategy to improve effectiveness in the setting of waning immunity and immune evasion from circulating SARS-CoV-2 variants. The US Food and Drug Administration authorized two bivalent mRNA booster vaccines that target the spike proteins of both the original SARS-CoV-2 strain and the Omicron B.4/B.5 variants (Pfizer COVID-19 vaccine: bivalent for individuals ≥5 years old, and Moderna COVID-19 vaccine: bivalent for individuals ≥6 years old) (figure 1 and figure 2) [1,2]. The Centers for Disease Control and Prevention (CDC) now recommends that all individuals ≥5 years old who have completed a primary COVID-19 vaccine series (including those who already received booster doses with monovalent vaccines) receive a single booster dose with one of the bivalent vaccines at least two months after the last vaccine dose [3]. Our approach is consistent with CDC recommendations. Although clinical data evaluating bivalent vaccines are limited, their use is supported by indirect evidence from trials and observational studies in which monovalent booster doses improved vaccine efficacy against infection and severe disease and by studies that indicate at least comparable immunogenicity with bivalent versus monovalent formulations. (See "COVID-19: Vaccines", section on 'Role of booster vaccinations'.)

NEUROLOGY (October 2022)

Sodium phenylbutyrate-taurursodiol for amyotrophic lateral sclerosis

For all patients with amyotrophic lateral sclerosis, we suggest treatment with sodium phenylbutyrate-taurursodiol (Grade 2B), in addition to riluzole and edaravone.

Sodium phenylbutyrate-taurursodiol (PB-TURSO) is a combination of two orally available drugs that each reduce neuronal cell death in preclinical models of amyotrophic lateral sclerosis (ALS). In a randomized trial of 137 patients with ALS (75 percent also taking riluzole and/or edaravone) who were within 18 months of symptom onset, patients assigned to PB-TURSO showed a slower median rate of monthly functional decline than those assigned to placebo by 24-week follow-up [4]. There were nonsignificant trends toward slower decline in both vital capacity and muscle strength with treatment. In a subsequent analysis of patients who continued open-label treatment (up to 35 months), those originally randomized to PB-TURSO had a longer median time to tracheostomy (26 versus 19 months) and a longer median time to first hospitalization [5]. Based on these results, the combination product received regulatory approval in the United States and Canada [6,7]. We now suggest use of PB-TURSO for all patients with ALS, along with riluzole (prioritized as initial therapy) and edaravone. (See "Disease-modifying treatment of amyotrophic lateral sclerosis", section on 'Efficacy'.)

GENERAL SURGERY (September 2022)

Role of wound packing after drainage of perianal and perirectal abscess

For most patients with a perianal or perirectal abscess, we suggest not packing the wound after drainage (Grade 2C).

After incision and drainage of a perianal or perirectal abscess, it is common practice to pack the wound, under the assumption that this will facilitate further drainage by wicking and prevent premature skin closure. In the PPAC2 trial of 443 patients with a primary perianal abscess, nonpacking, compared with packing, resulted in similar rates of fistula formation (11 versus 15 percent) and abscess recurrence (6 versus 3 percent), differences that were not statistically significant [8]. However, the nonpacking group had lower average pain scores (28 versus 38 on a 100-point visual analog scale). Given these and similar findings from two earlier small trials, we now suggest not packing the wound after drainage of perianal or perirectal abscess. (See "Perianal and perirectal abscess", section on 'Role of wound packing'.)

CARDIOVASCULAR MEDICINE (September 2022)

Anticoagulation for rheumatic mitral stenosis with atrial fibrillation

For patients with rheumatic mitral stenosis requiring anticoagulation (for atrial fibrillation, left atrial thrombus, or a prior embolic event), we recommend chronic anticoagulation with a vitamin K antagonist (eg, warfarin) rather than with a direct oral anticoagulant (Grade 1B). The target international normalized ratio is 2.5 (range 2.0 to 3.0).

Limited data have been available to guide anticoagulant choice in patients with rheumatic mitral stenosis and atrial fibrillation. A randomized trial enrolling over 4500 adults with rheumatic heart disease and atrial fibrillation found that the mortality and stroke rates were higher with rivaroxaban than with a vitamin K antagonist (VKA), and major bleeding rates were similar [9]. Based on these findings, for patients with rheumatic mitral stenosis and atrial fibrillation, we now recommend a VKA rather than a direct oral anticoagulant such as rivaroxaban. (See "Rheumatic mitral stenosis: Overview of management", section on 'Choice of anticoagulant'.)

PULMONARY AND CRITICAL CARE MEDICINE (August 2022)

Intravenous magnesium in severe COPD exacerbation

For patients having an acute COPD exacerbation who experience limited benefit from short-acting inhaled bronchodilators, we suggest intravenous magnesium (Grade 2C).

Intravenous magnesium has short-acting bronchodilator activity that is helpful for severe asthma attacks, but it has not previously been recommended for chronic obstructive pulmonary disease (COPD). A new systematic review and meta-analysis found a decrease in hospitalization rates with emergency department intravenous magnesium administration compared with placebo [10]. The effect size is similar to or better than that seen in the setting of asthma exacerbation. Based on these data, we now suggest intravenous magnesium for patients with severe COPD exacerbations who are not improving with inhaled bronchodilator therapy. (See "COPD exacerbations: Management", section on 'Magnesium sulfate'.)

NEPHROLOGY AND HYPERTENSION (June 2022)

Oral glucocorticoids for immunoglobulin A (IgA) nephropathy

For patients with IgA nephropathy who are considered to be at high risk of disease progression (ie, proteinuria ≥1 g/day despite at least three months of optimized supportive care), we suggest treatment with glucocorticoids plus supportive care rather than supportive care alone (Grade 2B).

In patients with immunoglobulin A (IgA) nephropathy who are at high risk for progressive disease, the effect of glucocorticoids on clinical outcomes has been uncertain. In a randomized trial of over 500 patients with IgA nephropathy, proteinuria ≥1 g/day, and an estimated glomerular filtration rate of 20 to 120 mL/min per 1.73 m2 after at least three months of supportive therapy, the addition of oral glucocorticoids (full- or reduced-dose) to supportive therapy slowed the decline of kidney function and reduced the risk of end-stage kidney disease compared with supportive therapy alone (19 versus 27 percent) [11]. Serious adverse events were more frequent with glucocorticoids than with placebo but occurred primarily among those receiving full rather than reduced doses of glucocorticoids. Based on these results, we now suggest use of glucocorticoids in most high-risk patients with IgA nephropathy. (See "IgA nephropathy: Treatment and prognosis", section on 'Glucocorticoid therapy'.)

INFECTIOUS DISEASES (June 2022)

COVID-19 vaccination in children 6 months and older

For children aged 6 months to 11 years old, we recommend COVID-19 vaccination (Grade 1B).

As of June 2022, the US Food and Drug Administration (FDA) has authorized BNT162b2 (Pfizer COVID-19 vaccine) and mRNA-1273 (Moderna COVID-19 vaccine) for use in children 6 months and older. Trials in children 6 months to 11 years have demonstrated that these vaccines, given at lower doses, elicit neutralizing immune responses comparable to those in adolescents and adults following standard doses [12-14]. Vaccination also reduces the risk of symptomatic COVID-19 in these populations, although the estimates of effect vary, in part because of different variants prevalent during the trials. There were no cases of vaccine-associated myocarditis in the trials; the precise risk is uncertain but is expected to be lower than that seen in older individuals. We agree with recommendations from the Centers for Disease Control and Prevention to give BNT162b2 or mRNA-1273 to children ages 6 months to 11 years. Clinicians should be aware that the dose and formulation used for children are different than those for adolescents and adults (table 1). (See "COVID-19: Vaccines", section on 'Summary and recommendations'.)

INFECTIOUS DISEASES (February 2022, Modified May 2022)

Updated recommendations for pneumococcal vaccination in adults

For all adults with an indication for pneumococcal vaccination (table 1), we suggest PCV20 rather than other vaccines (Grade 2C). For patients with immunocompromising conditions or risk for meningitis, some UpToDate authors also favor administering PPSV23 ≥8 weeks following the PCV20 dose.

In early 2022, the Advisory Committee on Immunization Practices (ACIP) updated guidance on pneumococcal vaccination to recommend either [15]:

20-valent pneumococcal conjugate vaccine (PCV20) alone (newly available), or

The combination of 15-valent pneumococcal conjugate vaccine (PCV15; newly available) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least a year afterward, except in high-risk individuals (eg, immunocompromising conditions, cochlear implant, or cerebrospinal fluid leak), in whom a shorter interval of ≥8 weeks may be used to maximize protection more quickly

Based largely on convenience, we now suggest PCV20 for all adults with indications for pneumococcal vaccination (table 2). Although the ACIP does not require it, some UpToDate authors also favor giving PPSV23 ≥8 weeks after PSV20 for immunocompromised patients and those with increased risk for meningitis in order to provide protection against serotypes present in PPSV23 that are absent from PCV20. (See "Pneumococcal vaccination in adults".)

OBSTETRICS, GYNECOLOGY AND WOMEN'S HEALTH (April 2022)

Treatment of chronic hypertension in pregnancy

For pregnant patients with nonsevere chronic hypertension (based on medical history or systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or both on at least two occasions at least four hours apart before 20 weeks of gestation), we recommend antihypertensive treatment (Grade 1B).

Traditionally, only severe chronic hypertension (blood pressure [BP] ≥160/110 mmHg) has been treated in pregnancy because of fetal safety concerns and lack of evidence of maternal benefit. In the Chronic Hypertension and Pregnancy (CHAP) trial, over 2400 pregnant people with nonsevere chronic hypertension (≥140/90 mmHg) were randomly assigned to active treatment (initiating/continuing antihypertensive treatment to keep BP <140/90 mmHg) or usual care (antihypertensive treatment only for BP ≥160/105 mmHg) [16]. Active treatment resulted in an 18 percent relative reduction in a composite adverse pregnancy outcome, including preeclampsia with severe features (23.3 versus 29.1 percent) and medically indicated preterm birth <35 weeks (12.2 versus 16.7 percent), with no adverse fetal effects. Based on this trial, we now recommend antihypertensive treatment for pregnant patients with chronic hypertension to keep BP <140/90 mmHg. We prefer labetalol or extended-release nifedipine. (See "Treatment of hypertension in pregnant and postpartum patients", section on 'Background'.)

ONCOLOGY (April 2022)

First-line therapy for high-risk, high-volume metastatic hormone-sensitive prostate cancer

For most patients with metastatic hormone-sensitive, high-risk, high-volume prostate cancer who are candidates for docetaxel, we recommend androgen deprivation therapy (ADT) plus docetaxel and darolutamide rather than ADT plus docetaxel alone (Grade 1B). Abiraterone is a reasonable alternative to darolutamide with promising but currently less robust data, particularly in those with metachronous metastatic disease.

Docetaxel plus androgen deprivation therapy (ADT) is a standard approach for initial treatment of patients with hormone-sensitive, high-risk, high-volume metastatic prostate cancer. Two trials now demonstrate an overall survival benefit from the addition of a second systemic agent to ADT plus docetaxel. In the ARASENS trial, the addition of darolutamide to ADT plus docetaxel improved overall survival and all secondary endpoints without worsening treatment-related toxicity in men with metastatic castration-sensitive prostate cancer (CSPC), and the benefits were similar in most subgroups [17]. In the PEACE-1 trial, the addition of abiraterone to ADT plus docetaxel also improved survival over ADT plus docetaxel alone in patients with de novo metastatic CSPC [18]. Largely based on results from the ARASENS trial, the combination of darolutamide plus docetaxel is now approved in the United States for treatment of metastatic CSPC [19]. (See "Initial systemic therapy for advanced, recurrent, and metastatic noncastrate (castration-sensitive) prostate cancer".)

INFECTIOUS DISEASES (February 2022)

Tenofovir alafenamide now a preferred NRTI agent for pregnant individuals with HIV

For most treatment-naïve individuals with HIV who are initiating antiretroviral therapy during pregnancy, we suggest tenofovir alafenamide-emtricitabine plus dolutegravir rather than other preferred three-drug combination regimens (Grade 2C).

Recommended antiretroviral regimens for individuals with HIV initiating treatment during pregnancy include two nucleoside reverse transcriptase inhibitor (NRTI) agents in conjunction with either an integrase inhibitor or a booster protease inhibitor. Based on accumulating safety and efficacy data in this population, the United States Department of Health and Human Services has added tenofovir alafenamide (TAF) to the list of preferred NRTIs to use for pregnant individuals with HIV [20]. In a recent trial, regimens containing TAF versus tenofovir disoproxil fumarate (TDF) resulted in similar virologic suppression rates, but TAF was associated with fewer adverse pregnancy outcomes. We generally initiate the NRTI combination of TAF-emtricitabine in this patient population unless there is significant concern for excessive gestational weight gain, in which case a TAF-containing regimen can be used. (See "Antiretroviral selection and management in pregnant women with HIV in resource-rich settings", section on 'Selecting the NRTI backbone'.)

PEDIATRICS (February 2022)

Duration of anticoagulation for low-risk provoked venous thromboembolism in pediatric patients

For pediatric patients with provoked venous thromboembolism who meet low-risk criteria, we suggest six weeks of anticoagulant therapy rather than observation or shorter or longer courses of treatment (Grade 2C).

The optimal duration of anticoagulant therapy for children with venous thromboembolism (VTE) is uncertain. Usual practice has been to treat for three months based largely upon evidence from adult studies. However, a recent clinical trial suggests that six weeks of therapy is sufficient for most pediatric patients with low-risk provoked VTE (ie, attributable to a transient risk factor) [21]. The trial enrolled 417 children with provoked VTE (catheter-associated in 50 percent; infection-related in 30 percent; surgery- or trauma-related in 20 percent) who were randomly assigned to six weeks or three months of anticoagulant therapy. At one year, rates of VTE recurrence were similarly low in both groups (1.1 and 1.6 percent, respectively). Based upon these findings, we now suggest a six-week course of treatment for pediatric patients with provoked VTE who met all of the following low-risk criteria:

No prior history of VTE

The VTE is not severe or life-threatening

The provoking risk factor resolves within six weeks

The thrombus resolves or is nonocclusive within six weeks

For patients with provoked VTE who do not meet these criteria, we continue to suggest three months of therapy. (See "Venous thrombosis and thromboembolism (VTE) in children: Treatment, prevention, and outcome", section on 'Provoked VTE'.)

HEMATOLOGY (January 2022)

Chimeric antigen receptor-T cell therapy for early relapse or refractory diffuse large B cell lymphoma

For patients with early first relapse of diffuse large B cell lymphoma or primary refractory disease, we recommend CD19-directed chimeric antigen receptor-T cell therapy using lisocabtagene maraleucel or axicabtagene ciloleucel, rather than autologous hematopoietic cell transplantation (Grade 1B).

Although autologous hematopoietic cell transplantation (HCT) has long been standard treatment in medically-fit patients with relapsed or refractory diffuse large B cell lymphoma (DLBCL), recent phase 3 trials compared transplantation with CD19-directed chimeric antigen receptor (CAR)-T products in these settings. In patients with early first relapse (<12 months after initial therapy) or primary refractory DLBCL, lisocabtagene maraleucel (liso-cel) and axicabtagene ciloleucel (axi-cel) improved event-free and overall survival relative to autologous HCT, with acceptable toxicity [22,23]. By contrast, another CD-19 CAR-T cell product, tisagenlecleucel, did not improve outcomes or toxicity relative to HCT [24]. CAR-T cell therapy is restricted to approved institutions and can be associated with life-threatening cytokine release syndrome and neurologic toxicity. We now recommend liso-cel or axi-cel for early relapsed or primary refractory DLBCL, when available; note that this guidance does not apply to later relapses (≥12 months). (See "Diffuse large B cell lymphoma (DLBCL): Suspected first relapse or refractory disease in medically-fit patients", section on 'Relapse <12 months or primary refractory DLBCL'.)

GENERAL SURGERY (December 2021)

No benefit of antibiotics for outpatient treatment of uncomplicated acute diverticulitis

For patients who meet criteria for outpatient treatment of acute colonic diverticulitis, we suggest not administering antibiotics (Grade 2B).

Antibiotics have been the cornerstone of diverticulitis treatment based upon retrospective studies and clinical experience. In a randomized trial (DINAMO) of 480 patients with imaging-confirmed uncomplicated acute diverticulitis who met criteria for outpatient treatment and whose symptoms were adequately controlled in the emergency department, supportive treatment (pain control and liquid diet) with or without antibiotics resulted in similarly low rates of unscheduled return visits (6.7 versus 7 percent) or hospitalizations (6 versus 3 percent) [25]. Based on this and two other similar trials, we now suggest not prescribing antibiotics when treating outpatients with uncomplicated acute diverticulitis (ie, nonsevere diverticular disease and no serious comorbidities) (algorithm 1). (See "Acute colonic diverticulitis: Medical management", section on 'No oral antibiotics'.)

EMERGENCY MEDICINE (ADULT AND PEDIATRIC) (November 2021)

New threshold for elevated blood lead in United States children

For children younger than six years of age in the United States, the reference value for an elevated blood level is 3.5 mcg/L (0.17 micromol/L).

Detectable blood lead levels (BLLs) are associated with neurocognitive deficits in infants and children <6 years old, and targeted screening of at-risk children is recommended. The Centers for Disease Control and Prevention has lowered the blood lead level (BLL) threshold for action to 3.5 mcg/dL (0.17 micromol/L) from the previous level of 5.0 mcg/dL (0.24 micromol/L) [26,27]. At or above this threshold, specific interventions should be taken based upon the degree of BLL elevation (table 3). For children with BLLs below 3.5 mcg/dL, the limit of detection for lead varies by laboratory, and the actual blood lead value may be close to or above the threshold. Thus, some children may need to be retested depending upon age or other risk factors. (See "Childhood lead poisoning: Management", section on 'Approach'.)

PEDIATRICS (August 2021)

Direct oral anticoagulants for venous thromboembolism in children ≥2 years

For most adolescents (≥12 years) with venous thromboembolism, after at least five days of initial parenteral therapy, we suggest a direct oral anticoagulant (DOAC; eg, dabigatran or rivaroxaban) rather than other agents (Grade 2B). For children ages 2 to <12 years old, either a DOAC or low molecular weight heparin is reasonable.

In 2021, the US Food and Drug Administration approved two direct oral anticoagulants (DOACs), dabigatran and rivaroxaban, for treatment of venous thrombosis and thromboembolism (VTE) in children [28,29]. These regulatory approvals were based upon two large multicenter pediatric trials demonstrating that dabigatran and rivaroxaban have similar efficacy and bleeding risk compared with low molecular weight heparin (LMWH) and warfarin [30,31]. Adolescents made up most of the trial populations, and children <2 years were underrepresented. DOACs are an attractive option since they are orally administered and do not require drug monitoring. We now suggest one of the approved DOACs (dabigatran or rivaroxaban) for treatment of VTE in adolescents, after at least five days of initial parenteral therapy. For children ages 2 to 11 years, either a DOAC or LMWH is acceptable. For infants and children <2 years, the efficacy and safety of DOACs remain uncertain, and we continue to suggest LMWH. (See "Venous thrombosis and thromboembolism (VTE) in children: Treatment, prevention, and outcome", section on 'Direct oral anticoagulants'.)

  1. EMERGENCY USE AUTHORIZATION (EUA) for PFIZER-BIONTECH COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5). https://www.fda.gov/media/161327/download (Accessed on September 02, 2022).
  2. EMERGENCY USE AUTHORIZATION (EUA) for MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5) BOOSTER DOSE FOR 6 YEARS OF AGE AND OLDER. https://www.fda.gov/media/161318/download (Accessed on October 13, 2022).
  3. Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html (Accessed on September 02, 2022).
  4. Paganoni S, Macklin EA, Hendrix S, et al. Trial of Sodium Phenylbutyrate-Taurursodiol for Amyotrophic Lateral Sclerosis. N Engl J Med 2020; 383:919.
  5. Paganoni S, Hendrix S, Dickson SP, et al. Effect of sodium phenylbutyrate/taurursodiol on tracheostomy/ventilation-free survival and hospitalisation in amyotrophic lateral sclerosis: long-term results from the CENTAUR trial. J Neurol Neurosurg Psychiatry 2022.
  6. Notice of Compliance with Conditions - Health Canada (Abrioza) https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/notice-compliance/conditions/qualifying-notice-albrioza-253502.html (Accessed on August 01, 2022).
  7. US FDA label for Sodium phenylbutyrate and taurursodiol https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/216660s000lbledt.pdf (Accessed on September 30, 2022).
  8. Newton K, Dumville J, Briggs M, et al. Postoperative Packing of Perianal Abscess Cavities (PPAC2): randomized clinical trial. Br J Surg 2022; 109:951.
  9. Connolly SJ, Karthikeyan G, Ntsekhe M, et al. Rivaroxaban in Rheumatic Heart Disease-Associated Atrial Fibrillation. N Engl J Med 2022; 387:978.
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  12. Vaccines and Related Biological Products Advisory Committee Meeting. FDA Briefing Document: EUA amendment request for use of the Moderna COVID-19 Vaccine in children 6 months through 17 years of age. June 14-15, 2022 https://www.fda.gov/media/159189/download (Accessed on June 16, 2022).
  13. Vaccines and Related Biological Products Advisory Committee Meeting. FDA Briefing Document: EUA amendment request for Pfizer-BioNTech COVID-19 Vaccine for use in children 6 months through 4 years of age, June 15, 2022. https://www.fda.gov/media/159195/download (Accessed on June 17, 2022).
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  15. Kobayashi M, Farrar JL, Gierke R, et al. Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:109.
  16. Tita AT, Szychowski JM, Boggess K, et al. Treatment for Mild Chronic Hypertension during Pregnancy. N Engl J Med 2022; 386:1781.
  17. Smith MR, Hussain M, Saad F, et al. Darolutamide and Survival in Metastatic, Hormone-Sensitive Prostate Cancer. N Engl J Med 2022; 386:1132.
  18. Fizazi K, Foulon S, Carles J, et al. Abiraterone plus prednisone added to androgen deprivation therapy and docetaxel in de novo metastatic castration-sensitive prostate cancer (PEACE-1): a multicentre, open-label, randomised, phase 3 study with a 2 × 2 factorial design. Lancet 2022; 399:1695.
  19. https://www.accessdata.fda.gov/drugsatfda_docs/appletter/2022/212099Orig1s002ltr.pdf (Accessed on August 16, 2022).
  20. Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States. https://clinicalinfo.hiv.gov/en/guidelines/perinatal/whats-new-guidelines (Accessed on January 18, 2022).
  21. Goldenberg NA, Kittelson JM, Abshire TC, et al. Effect of Anticoagulant Therapy for 6 Weeks vs 3 Months on Recurrence and Bleeding Events in Patients Younger Than 21 Years of Age With Provoked Venous Thromboembolism: The Kids-DOTT Randomized Clinical Trial. JAMA 2022; 327:129.
  22. Kamdar M, Solomon SR, Arnason JE, et al. Lisocabtagene Maraleucel (liso-cel), a CD19-Directed Chimeric Antigen Receptor (CAR) T Cell Therapy, Versus Standard of Care (SOC) with Salvage Chemotherapy (CT) Followed By Autologous Stem Cell Transplantation (ASCT) As Second-Line (2L) Treatment in Patients (Pts) with Relapsed or Refractory (R/R) Large B-Cell Lymphoma (LBCL): Results from the Randomized Phase 3 Transform Study [#91]. Blood (ASH Annual Meeting Abstracts) 2021.
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  26. Baum C, Hauptman M, Newman N, Woolf A. Recommendations on management of childhood lead exposure: A resource for health professionals. Pediatric Environmental Health Specialty Units and the American Academy of Pediatrics. https://www.pehsu.net/_Library/facts/PEHSU_Fact_Sheet_Lead_Management_Health_Professionals_Final.pdf (Accessed on November 08, 2021).
  27. Centers for Disease Control and Prevention. Recommended actions based on blood lead level: Summary of recommendationsfor follow-up and case management of children based on initial screening capillary and confirmed* venous blood lead levels. https://www.cdc.gov/nceh/lead/advisory/acclpp/actions-blls.htm (Accessed on November 08, 2021).
  28. US Food and Drug Administration. FDA Approves First Oral Blood Thinning Medication for Children. 2021. Available at: https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-blood-thinning-medication-children (Accessed on June 25, 2021).
  29. US Food and Drug Administration. FDA approves drug to treat, help prevent types of blood clots in certain pediatric populations. 2021. Available at: https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-drug-treat-help-prevent-types-blood-clots-certain-pediatric-populations (Accessed on January 14, 2022).
  30. Halton J, Brandão LR, Luciani M, et al. Dabigatran etexilate for the treatment of acute venous thromboembolism in children (DIVERSITY): a randomised, controlled, open-label, phase 2b/3, non-inferiority trial. Lancet Haematol 2021; 8:e22.
  31. Male C, Lensing AWA, Palumbo JS, et al. Rivaroxaban compared with standard anticoagulants for the treatment of acute venous thromboembolism in children: a randomised, controlled, phase 3 trial. Lancet Haematol 2020; 7:e18.
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