When available, Factor Xa inhibitors seems to be a better choice for treating these patients.
Commentary: D-dimer Predicts Long-Term Mortality, Vascular Events, Cancer – American College of Cardiology, Latest in Cardiology (free) AND D-Dimer Predicts CV, Cancer Mortality Over 16 Years in Patients With Stable CHD – Medscape (free registration required)
Related reviews: Toxicities of chimeric antigen receptor T cells: recognition and management – Blood (free) AND Toxicity and management in CAR T-cell therapy – Molecular Therapy Oncolytics (free) AND New drugs, new toxicities: severe side effects of modern targeted and immunotherapy of cancer and their management – Critical Care (free)
Long-Term Follow-up of Monoclonal Gammopathy of Undetermined Significance – New England Journal of Medicine (link to abstract – $ for full-text)
Commentaries: Monoclonal Gammopathy of Undetermined Significance: Risk for Progression to Cancer, Other Disorders Examined – Physician’s First Watch (free) AND Patients with blood cancer precursor at risk of developing cancer even after 30 years – Mayo Clinic, via EurekAlert (free)
Treatment algorithm 1: Essential thrombocythemia treatment algorithm 2018 – Blood Cancer Journal (free)
Treatment algorithm 2: Polycythemia vera treatment algorithm 2018 – Blood Cancer Journal (free)
Myeloablative Autologous Stem-Cell Transplantation for Severe Scleroderma – The New England Journal of Medicine (link to abstract – $ for full-text)
Carfilzomib-Associated Cardiovascular Adverse Events: A Systematic Review and Meta-analysis – JAMA Oncology (link to abstract – $ for full-text)
Commentaries: Carfilzomib can lead to cardiovascular toxicity in multiple myeloma patients – eCancer News (free) AND Higher Rates of Cardiovascular Adverse Events in Patients with MM Treated With Carfilzomib – AJMC (free) AND Important CV Risk Seen With Carfilzomib in Multiple Myeloma – Medscape (free registration required)
Original article: Age of Red Cells for Transfusion and Outcomes in Critically Ill Adults – New England Journal of Medicine (link to abstract – $ for full-text)
Bisphosphonates in Multiple Myeloma – Cochrane Library (free summary)
Original article: Bisphosphonates in multiple myeloma: an updated network meta-analysis – Cochrane Library (free)
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”.
Related commentary: CAR T-Cell Therapy Makes Further Inroads in Lymphoma and Myeloma – ASCO Post (free)
Related Study: Chimeric Antigen Receptor T Cells in Refractory B-Cell Lymphomas – New England Journal of Medicine (free), Editorial: A Milestone for CAR T Cells (free) AND Visual Abstract (free)
Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial – Academic Emergency Medicine (link to abstract – $ for full-text)
Commentary: Topical TXA in Epistaxis – R.E.B.E.L.em (free)
Commentaries: Pharmacomechanical Thrombolysis for Deep-Vein Thrombosis – NEJM Resident 360 (free) AND Pharmacomechanical Thrombolysis for DVT – American College of Cardiology, Latest in Cardiology (free)
Pharmacomechanical thrombolysis did not result in lower risk of post-thrombotic syndrome and was associated with higher risk of major bleeding.
Commentary and Summary: Consensus for Management of Bleeding on Oral Anticoagulants – American College of Cardiology, Latest in Cardiology (free)
Commentaries: TRICS III: Restrictive Red-Cell Transfusion Noninferior to Liberal Use in Cardiac Surgery – TCTMD (free) AHA: Restrictive Blood Transfusion OK for Select Patients – MedPage Today (free registration required)
Related article: Transfusion Requirements After Cardiac Surgery: The TRACS Randomized Controlled Trial – JAMA (free)
European guidelines on perioperative venous thromboembolism prophylaxis (free PDF articles):
Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients – The Lancet (free)
Commentaries: Tranexamic acid: is it about time? – The Lancet (free) Rapid use of blood drug could save thousands of lives, study finds – The Guardian (free) AND Severely bleeding patients must receive lifesaving drug within minutes, not hours – London School of Hygiene & Tropical Medicine, via EurekAlert (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”.
“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”.
Original article: Prophylactic antibiotics for preventing pneumococcal infection in children with sickle cell disease – Cochrane Library (link to abstract – $ for full-text)
Summary with 10 key points to remember: Thrombophilia Testing and Venous Thrombosis – American College of Cardiology, Latest in Cardiology (free)
See also: Thrombophilia Testing and Venous Thrombosis – NEJM Resident 360 (free)
Original article: Thrombophilia Testing and Venous Thrombosis – New England Journal of Medicine (link to abstract – $ for full-text)
Commentaries: Blood Boundaries: Should Transfusions Be Matched by Sex? – Scientific American (free) AND Are transfusions harmful to men if the blood comes from women who have been pregnant? – STAT (free) AND Receipt of Blood Transfusion From Previously Pregnant Donor Associated with Increased Risk of Death Among Male Recipients – The JAMA Network (free)
Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials – The Lancet Haematology (free)
Commentaries: Treatment of iron deficiency is getting trendy – The Lancet Haematology (free) AND Taking Iron Every Other Day Linked to Better Absorption in Iron-Deficient Women – Physician’s First Watch (free)
Association Between Use of Non–Vitamin K Oral Anticoagulants With and Without Concurrent Medications and Risk of Major Bleeding in Nonvalvular Atrial Fibrillation – JAMA (link to abstract – $ for full-text)
Commentaries: Use of Non-Vitamin K Blood-Thinners with Certain Medications Associated With Increased Risk of Major Bleeding – The JAMA Network (free) AND Drug reactions with NOACs in AFib patients could result in major bleeding problems – Cardiovascular Business (free)
Association Between Use of Antithrombotic Medication and Hematuria-Related Complications – JAMA (link to abstract – $ for full-text)
Commentaries: The price of blood is measured in iron – The Lancet (free) AND Increasing frequency of blood donation has no major side effects – ScienceDaily (free)
D-dimer to guide the intensity of anticoagulation in Chinese patients after mechanical heart valve replacement: a randomized controlled trial – Journal of Thrombosis and Haemostasis (link to abstract – $ for full-text)
Source: ACP Journal Wise ($)
Prevalence of Anemia 10 Years After Roux-en-Y Gastric Bypass in a Single Veterans Affairs Medical Center – JAMA Surgery (link to abstract – $ for full-text)
Association of Guideline-Adherent Antibiotic Treatment With Readmission of Children With Sickle Cell Disease Hospitalized With Acute Chest Syndrome – JAMA Pediatrics (link to abstract – $ for full-text)
Commentaries: Acute Chest Syndrome in Pediatric Sickle-cell Disease: Antibiotic Guidelines Matter – Medscape (free registration required) AND Antibiotic Rx adherence varies widely in sickle cell care – MedicalXpress (free)
Commentaries: Red blood cells for transfusion like a good red: A little older, a little better – Monash University, via ScienceDaily (free) AND Is Older Blood OK to Use in a Transfusion? – WebMD (free)
Effect of Genotype-Guided Warfarin Dosing on Clinical Events and Anticoagulation Control Among Patients Undergoing Hip or Knee Arthroplasty: The GIFT Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
Commentaries: Genotyping Reduces Adverse Events with Warfarin – Cardiobrief (free) AND Genotype-Guided Warfarin Dosing Reduces Adverse Events After Hip, Knee Arthroplasty – Physician’s First Watch (free)
Original article: Optimisation of chemotherapy and radiotherapy for untreated Hodgkin lymphoma patients with respect to second malignant neoplasms, overall and progression-free survival: individual participant data analysis – Cochrane Library (link to abstract – $ for full-text)
Implementing a Health System–wide Patient Blood Management Program with a Clinical Community Approach – Anesthesiology (link to abstract – $ for full-text)
Commentary: FDG PET/CT Helps Identify Malignancy Source in Paraneoplastic Syndrome – Medscape (free registration required)
Diagnosis and empirical treatment of fever of unknown origin (FUO) in adult neutropenic patients: guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) (free)
Related Guidelines: Management of febrile neutropaenia: ESMO Clinical Practice Guidelines (free) AND Guideline for the Management of Fever and Neutropenia in Children With Cancer and Hematopoietic Stem-Cell Transplantation Recipients: 2017 Update (free)
Effect of Palliative Care on Aggressiveness of End-of-Life Care Among Patients With Advanced Cancer – Journal of Oncology Practice (link to abstract – $ for full-text)
Commentaries: Palliative Care May Substantially Decrease Health-Care Utilization in Patients With Advanced Cancer – ASCO Post (free) AND End-of-Life Palliative Care Lowered Utilization for Patients With Cancer – AJMC (free) AND Palliative Care Cut Healthcare Use in Advanced Cancer – MedPage Today (free registration required)
Clinical Practice Recommendations on Indication and Timing of Hematopoietic Cell Transplantation in Mature T-Cell and NK/T-Cell Lymphomas: an International Collaborative Effort on Behalf of the Guidelines Committee of the American Society for Blood and Marrow Transplantation (link to abstract – $ for full-text)
Commentary and Summary: Guideline on HCT for Certain Lymphoma Types – Hematology News (free registration required)
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)
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.
Screening for Occult Cancer in Patients With Unprovoked Venous Thromboembolism: A Systematic Review and Meta-analysis of Individual Patient Data – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentaries: Outcomes of limited cancer screening after unprovoked VTE similar to extensive screening – ACP Hospitalist (free) AND Cancer Screening Not Recommended in Patients With VTEs – Medscape (free registration required) AND Extensive cancer screening may not improve outcomes for patients with unprovoked venous thromboembolism – 2 Minute Medicine (free) AND Screening for Occult Cancer in Patients With Unprovoked Venous Thromboembolism – ASCO Post (free)
Risk of Arterial Thromboembolism in Patients With Cancer – Journal of The American College of Cardiology (link to abstract – $ for full-text)
Commentaries: Cancer Patients at Heightened Risk for Arterial Thromboembolism – American College of Cardiology, Latest in Cardiology (free) AND Thromboembolism Risk Doubled in Cancer Patients – Medscape (free registration required) AND Cancer patients carry double the short-term risk of arterial thromboembolism – Cardiovascular Business (free) AND Short-Term Risk of Arterial Thromboembolism in Newly Diagnosed Patients With Cancer – ASCO Post (free)
The effects of physical activity and fatigue on cognitive performance in breast cancer survivors – Breast Cancer Research and Treatment (link to abstract – $ for full-text)
Commentary: Exercise Improves Cognitive Function in Breast CA Survivors – Medscape (free registration required)
Editorial: Bronchoscopy and bleeding risk – European Respiratory Review (free)
Effects of Non–Vitamin K Antagonist Oral Anticoagulants Versus Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease: A Systematic Review and Meta‐Analysis – Journal of The American Heart Association (free)
“Among patients with AF and native VHD, NOACs reduce stroke and systemic embolism compared with warfarin”.
Prophylactic Early Erythropoietin for Neuroprotection in Preterm Infants: A Meta-analysis – Pediatrics (link to abstract – $ for full-text)
Commentary: Early EPO Offers Neuroprotection for Preemies: Meta-analysis – Medscape (free registration required)
Commentary and perspectives on graft-versus-host disease.
Editorial: Bispecific Antibody Therapy in Hemophilia (free)
Commentaries: Disruptive technology for the treatment of hemophilia – Children’s Hospital Los Angeles, via EurekAlert (free) AND Novel Hemophilia A Treatments Advance – MedPage Today (free registration required) AND Emicizumab Replaces Factor VIII Function in Hemophilia A – Medscape (free registration required)
Dose-Reduced Versus Standard Conditioning Followed by Allogeneic Stem-Cell Transplantation for Patients With Myelodysplastic Syndrome: A Prospective Randomized Phase III Study of the EBMT (RICMAC Trial) – Journal of Clinical Oncology (free)
Commentaries: Reduced-Intensity vs Standard Conditioning Followed by ASCT in Myelodysplastic Syndrome – ASCO Post (free) AND Results of prospective randomized phase III study of the EBMT (Ricmac trial) dose-reduced versus standard conditioning followed by allogeneic stem cell transplantation for patients with myelodysplastic syndrome – European Society for Blood and Marrow Transplantation, via EurekAlert (free)
Source: EvidenceAlerts (free resource to find articles of interest)
Selection of state-of-the-art open access reviews on thrombosis and hemostasis, celebrating the 60th anniversary of the Journal – Thrombosis and Haemostasis (free PDF Articles)
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.
Clinical Review: Optimizing diagnostic testing for venous thromboembolism – Cleveland Clinic Journal of Medicine (free)
New available guidelines are:
Clinical Review: Iron substitution in the treatment of chronic heart failure – Swiss Medical Weekly (free)
Clinical Review: Current treatment approaches for NK/T-cell lymphoma – Journal of Clinical and Experimental Hematopathology (free PDF)
Direct oral anticoagulants for treatment of HIT: update of Hamilton experience and literature review – Blood (link to abstract – $ for full-text)
This literature review and observational study suggest direct oral anticoagulants (rivaroxaban, apixaban, dabigatran) are safe and effective for the treatment of Heparin-induced Thrombocytopenia.
Benefits and Risks of Antithrombotic Therapy in Essential Thrombocythemia: A Systematic Review – Annals of Internal Medicine (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”
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).
Cancer drugs are getting better and dearer – The Economist (a few articles per month are free) (RT @pash22 see Tweet)
See more articles and commentaries about “financial toxicity” of cancer treatments in our April 27 issue, see #8.
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.
Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis – British Journal of Sports Medicine (free)
Clinical relevance of thrombocytosis in primary care: a prospective cohort study of cancer incidence using English electronic medical records and cancer registry data – British Journal of General Practice (link to abstract – $ for full-text)
Commentaries: Cautions and caveats help buoy Guardian story on using high platelet count for cancer detection – HealthNewsReview (free) High blood platelet count ‘as good a cancer predictor as a lump in the breast’ – The Guardian (free)
Thrombocytosis seems to be a risk marker of cancer in adults, but questions remain about the clinical usefulness of these findings.
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)
Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial – The Lancet (free)
Editorial: WOMAN: reducing maternal deaths with tranexamic acid (free)
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)
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%.
“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)”
“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)”
Comprehensive review covering the most common oncological emergencies.
Browse Appropriateness Criteria Topics (free)
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.
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.
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.