AANEM News Express Related to Patient Safety

AANEM News Express

Patient Safety: NM Complications of Immune Checkpoint Inhibitors

Immune checkpoint inhibitors (ICPI’s) are monoclonal antibodies that target the immune checkpoints programmed death 1 (PD1), programmed death ligand 1 (PDL-1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) on T cells and promote immune mediated destruction of cancer cells. They are used to treat a variety of cancers including breast, bladder, cervical, colon, lung cancer, Hodgkin’s lymphoma, melanoma, etc. ICPI treatment is associated with an array of immune related adverse events affecting many organ systems. Neurologic adverse events have also been reported.

Practice: CMS Releases Proposed Updates to Physician Fee Schedule and the Quality Payment Program

AANEM policy staff is diligently reviewing the 1,700+ page rule that was issued by the CMS on July 13, 2021. Here are a few highlights from the proposal. 

Patient Safety: Safety of DOACs in Needle EMG

Limited data is available regarding the risk of bleeding with EMG in patients taking DOACs. One small retrospective study looked at the risk of bleeding after EMG in this patient population and in those taking warfarin, using ultrasound of studied muscles. Nine patients out of the 58 included had hemorrhagic complications, six of which were classified as clinically relevant non-major bleeding and three as asymptomatic bleeding, with a higher incidence of hemorrhage in the DOAC group as compared to the warfarin group. No cases of major bleeding were found.

Patient Safety: EMG/NCS and Risk of Bleeding

Electrodiagnostic testing (needle electromyography) in patients with bleeding diathesis is associated with greater risk of bleeding when compared to general population. It is recommended that caution should be used when deciding on electrodiagnostic testing in patients with platelet counts less than 50,000 and INR greater than 1.5-2.0.