EM Pharmacotherapy Literature of 2024

Written by Amanda Mathews

Spoon Feed
This article reviewed major ED pharmacotherapy studies from 2024, including topics such as anticoagulation reversal, seizure prophylaxis in TBI, and thrombolysis in ischemic stroke.

Update your pharmacopia 
There are a lot of great studies highlighted in this article. Here are a few big takeaways.

• Resuscitation
  • ACC (American College of Cardiology) clinical recommendation for ED treatment of acute heart failure is initial IV dosing of 1-2.5x home oral-dose furosemide, with 2.5x dosing associated with greater fluid loss, increased weight loss, and decreased dyspnea at 72 hours.
  • An international multispecialty task force looked at corticosteroid use in sepsis, ARDS, and community-acquired pneumonia (CAP). Corticosteroids are suggested for use in adults hospitalized in ARDS and recommended for adults hospitalized in severe CAP.
• Trauma
  • Updated guidelines for antibiotic prophylaxis in trauma. See Table at the bottom of this summary. 
• TBI/ICH
  • Clinical practice guideline showed no evidence of benefit or harm regarding prophylactic anti-seizure medication in moderate to severe TBI. If used, guidelines recommend leviteracetam.
  • Two studies looked at TXA use in TBI. One meta-analysis did not show any mortality benefit or overall improvement in clinical outcome, but there was a decrease in hematoma expansion and hemorrhagic volume. The other study looked at TXA dosing and found that, if you do give TXA, a 2g IV initial dosing strategy is associated with better six-month disability scores. 
• Anticoagulation reversal
  • Two studies looked at adexanet alfa for reversal of Factor Xa inhibitor associated bleeding. Neither study showed improved functional outcomes in patients who received adexanet alfa compared to prothrombin complex concentrate (PCC).
  • Researchers compared fixed-dose with weight-based dosing for PCC reversal of vitamin K antagonist bleeding. Fixed dose was effective in achieving INR <2.0 and had fewer adverse effects compared to weight based dosing; however, weight based was better at tighter INR control of <1.5.
• Ischemic stroke
  • Multiple studies looked at tenecteplase (TNK) vs. alteplase for use in ischemic stroke. Ultimately, these studies showed TNK dosed at 0.25 mg/kg (max 25mg) was noninferior to alteplase 0.9 mg/kg (max 90mg) when used in acute ischemic stroke within 4.5 hours of symptom onset. 
• Severe agitation
  • ACEP subcommittee published a clinical policy on medication for the treatment of severe agitation. The committee favored the combination of droperidol and midazolam if possible, and droperidol if only a single drug can be used. If droperidol is unavailable, they recommended an atypical anti-psychotic.

How does this change my practice?
This is a really great summary article that is a must-read for any practicing ED physician. Many of these subjects have been covered on Journal Feed in the last year, and there will continue to be more studies published on these topics moving forward. I enjoyed this review on important topics like IV thrombolysis and AC reversal.

Source
CuratED: The emergency medicine pharmacotherapy literature of 2024. Am J Emerg Med. 2025 Jul;93:146-153. doi: 10.1016/j.ajem.2025.03.046. Epub 2025 Mar 24. PMID: 40203497