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NEWS - Hematology

Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non–Vitamin‐K Oral Anticoagulants (RAF‐NOACs) Study – Journal of the American Heart Association (free)

“Composite rates of recurrence and major bleeding were 12.4% in patients who initiated NOACs within 2 days after acute stroke, 2.1% in those who initiated NOACs between 3 and 14 days, and 9.1% in patients who initiated NOACs >14 days after acute stroke. Future randomized studies to assess timing of initiation and choice of agent in patients with acute stroke and AF are warranted”.


Association of Warfarin Use With Lower Overall Cancer Incidence Among Patients Older Than 50 Years – JAMA Internal Medicine (free)

“In this population-based cohort study of 1.256.725 persons, there was a significantly lower age- and sex-adjusted incidence rate ratio of cancer among warfarin users vs nonusers”.


Pregnancy, thrombophilia, and the risk of a first venous thrombosis: systematic review and bayesian meta-analysis – The BMJ (free)

“Women with antithrombin, protein C, or protein S deficiency or with homozygous factor V Leiden should be considered for antepartum or postpartum thrombosis prophylaxis, or both”.


FDA News Release: FDA approval brings first gene therapy to the United States (free)

Commentaries: A $475,000 cancer drug: Wall Street sees ‘bargain’; patients see ‘completely broken’ system – HealthNewsReview (free) FDA Approves First CAR-T Cell Therapy for Pediatric Acute Lymphoblastic Leukemia – National Institutes of Health (free) AND FDA Approves First Gene-Altering Leukemia Treatment, Costing $475.000 – New York Times (10 articles per month are free) AND The FDA Approves a Landmark Cancer Drug – The Atlantic (free)

“…is a cancer therapy that represents several things at once: a game-changing way to treat cancer through genetic engineering, a novel paradigm for the biotech business, and the latest turn in the debate over just how astronomically expensive a life-saving therapy can be”. (from The Atlantic)


Deferasirox for managing iron overload in people with thalassaemia – Cochrane Library (free)

Full review: Deferasirox for managing iron overload in people with thalassaemia – Cochrane Library (link to abstract – $ for full-text)

Iron chelation with oral Deferasirox (instead of injected deferoxamine) may offer an important treatment option for people with thalassaemia and secondary iron overload.


Venous Thromboembolism Prophylaxis in Major Orthopedic Surgery: Systematic Review Update. Comparative Effectiveness Review – Agency for Healthcare Research and Quality (free report and summary)

See also: Executive summary (free PDF)

Source: ACP Journal Wise ($ resource to find articles of interest)

Comprehensive review on the evidence regarding thromboembolism prophylaxis in major orthopedic surgery.


Direct oral anticoagulants for treatment of HIT: update of Hamilton experience and literature review – Blood (link to abstract – $ for full-text)

Source: Direct Oral Anticoagulants for Heparin-Induced Thrombocytopenia – Journal Watch ($)

This literature review and observational study suggest direct oral anticoagulants (rivaroxaban, apixaban, dabigatran) are safe and effective for the treatment of Heparin-induced Thrombocytopenia.


A Meta-analysis of the Impact of Aspirin, Clopidogrel, and Dual Antiplatelet Therapy on Bleeding Complications in Noncardiac Surgery – Annals of Surgery (link to abstract – $ for full-text)

Source: EvidenceAlerts (free resource to find articles of interest)

“Antiplatelet therapy at the time of noncardiac surgery confers minimal bleeding risk with no difference in thrombotic complications. In many cases, it is safe to continue antiplatelet therapy in patients with important indications for their use”


Nucleated red blood cells, critical illness survivors and postdischarge outcomes: a cohort study – Critical Care (free)

“Presence of nucleated RBCs is a robust predictor of post-discharge mortality and unplanned hospital readmission” (RT @Crit_Care see Tweet)


Non–Vitamin K Antagonist Oral Anticoagulant Dosing in Patients With Atrial Fibrillation and Renal Dysfunction – Journal of The American College of Cardiology (link to abstract – $ for full-text)

Commentary: NOAC Doses: Just Stick to the Label – MedPage Today (free registration required)

“Among the 1,473 patients with a renal indication for dose reduction, 43.0% were potentially overdosed, which was associated with a higher risk of major bleeding”


Effect of Low-Dose Ferrous Sulfate vs Iron Polysaccharide Complex on Hemoglobin Concentration in Young Children With Nutritional Iron-Deficiency Anemia: A Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)

The JAMA Network – For the Media: Treating Nutritional Iron-Deficiency Anemia in Children (free)

Commentaries: Ferrous Sulfate Drops Tied to Higher Hemoglobin Increases in Kids with Anemia – Physician’s First Watch (free) AND Traditional treatment is better for iron-deficiency anaemia in children – OnMedica (free) AND Ferrous Sulfate Effective for Iron-Deficiency Anemia in Kids – Medscape (free registration required)

Researchers expected that Iron Polysaccharide Complex would restore hemoglobin more effectively, because it is designed to be tolerated better, but the proportion of infants and children with a complete resolution of iron-deficiency anemia was higher in the ferrous sulfate group (29 percent vs 6 percent).


Maternal and Fetal Outcomes of Anticoagulation in Pregnant Women With Mechanical Heart Valves – Journal of The American College of Cardiology (free)

Commentaries: Warfarin OK in Expectant Moms with Mechanical Heart Valve – MedPage Today (free registration required) AND Anticoagulation in Pregnant Women With Mechanical Valves – American College of Cardiology, Latest in Cardiology (free) (RT @keaglemd see Tweet)

In this meta-analysis, warfarin was associated with lower risk of adverse maternal outcomes, whereas LMWH was associated with lower risk of adverse fetal outcomes.


Association of Donor Age and Sex With Survival of Patients Receiving Transfusions – JAMA Internal Medicine (link to abstract – $ required for full-text)

Source: Blood Donor Age, Sex Do Not Affect Outcomes After All – Medscape (free registration required)

“After reviewing almost 1 million transfusions, the researchers concluded all donations are about the same” (RT @theheartorg see Tweet)


Prospective, before-after cohort study: Standardized Criteria for Palliative Care Consultation on a Solid Tumor Oncology Service Reduces Downstream Health Care Use – Journal of Oncology Practice (free)

Editorial: Making the Right Thing Easier to Do: Standardized Integration of Oncology and Palliative Care – Journal of Oncology Practice (free)

Related Guideline: Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update (free)

Commentaries on the study: Standardized Palliative Care Consults Cut Cancer Readmissions – Also, less chemotherapy after discharge – MedPage Today (free registration required) AND Standardized Cancer Palliative Care Consults Linked to Stronger Home-Based Support – AJMC (free)

Patients with at least one of the following 4 criteria: 1) advanced solid tumor; 2) prior hospitalization within 30 days; 3) hospitalization > 7 days; or 4) active symptoms – received automatic palliative care consultation. The rates of 30-day readmissions dropped from 35% to 18% and chemotherapy after discharge dropped from 44% to 18%.


European Association of Urology releases its 1st thromboprophylaxis guideline (free)


Procedure-specific Risks of Thrombosis and Bleeding in Urological Cancer Surgery: Systematic Review and Meta-analysis – European Urology (free)

“Extended thromboprophylaxis is warranted in some procedures (eg, open and robotic cystectomy) but not others (eg, robotic prostatectomy without pelvic lymph node dissection in low-risk patients)


Procedure-specific Risks of Thrombosis and Bleeding in Urological Non-cancer Surgery: Systematic Review and Meta-analysis – European Urology (free)

“Extended prophylaxis is warranted for some procedures (eg, kidney transplantation procedures in high-risk patients) but not others (transurethral resection of the prostate and reconstructive female pelvic surgery in low-risk patients)”


Emergencies in Hematology and Oncology – Mayo Clinic Proceedings (free)

Comprehensive review covering the most common oncological emergencies.


ACR Appropriateness Criteria Adds Topics, Covers More Clinical Variants Than Ever Before (free)

Browse Appropriateness Criteria Topics (free)

Source: Newswise

This comprehensive guide from American College of Radiology (ACR) covers 230 topics with more than 1,100 clinical indications and has just been updated. It is a very useful resource for doctors in all specialties to guide which exam is most appropriate in each clinical situation.


Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation and Valvular Heart Disease – Journal of the American College of Cardiology (free)

Source: SciCombinator

Except for patients with moderate/severe mitral stenosis or mechanical heart valves, who were excluded in most trials, high-dose NOACs was as effective and safe for patients with valvular heart disease as for patients without valvular disorders.


Validating the HERDOO2 rule to guide treatment duration for women with unprovoked venous thrombosis: multinational prospective cohort management study – The BMJ (free)

Source: Richard Lehman’s weekly review

HERDOO2 rule stands for Hyperpigmentation, Edema, or Redness in either leg; D-dimer level ≥250 μg/L; Obesity with body mass index ≥30; or Older age, ≥65 years. The authors concluded that women with a first unprovoked VTE event and none or one of the HERDOO2 criteria have a low risk (3.0% per patient year) of recurrent VTE and can safely discontinue anticoagulants after completing short term treatment.


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