Hematology (all articles)
RCT | Noninferiority shown between DOACs and LMWH for recurrent VTE prevention in cancer patients
5 Jun, 2023 | 13:50h | UTCSummary: This unblinded, pragmatic, noninferiority randomized clinical trial aimed to assess the efficacy of direct oral anticoagulants (DOACs) against low-molecular-weight heparin (LMWH) in preventing recurrent venous thromboembolism (VTE) in patients with cancer. The study included 671 patients from 67 oncology centers, with a new clinical or radiological diagnosis of VTE.
Participants were randomly assigned to receive either a DOAC or LMWH for 6 months, and treating physicians selected and prescribed the drugs based on considerations like availability and drug-drug interactions. The primary outcome was the rate of recurrent VTE at 6 months. Findings revealed that the DOAC group had a recurrent VTE rate of 6.1% as compared to 8.8% in the LMWH group, showing noninferiority. Both groups had statistically similar rates of major bleeding and severe adverse events.
This pragmatic study included patients with advanced cancer and brain metastases, impaired performance status, and reduced liver or kidney function, making it more representative of routine oncology practice. Moreover, patient adherence to DOAC treatment was significantly higher than to LMWH. Nevertheless, the study had limitations, including the lack of blinding and underrepresentation of certain racial and ethnic groups.
In conclusion, this trial suggests that DOACs were noninferior to LMWH for preventing recurrent VTE in patients with cancer over a 6-month follow-up period, supporting the use of DOACs in this population for VTE prevention. Further research is needed to confirm these results and investigate long-term outcomes.
Article: Direct Oral Anticoagulants vs Low-Molecular-Weight Heparin and Recurrent VTE in Patients With Cancer: A Randomized Clinical Trial – JAMA (free for a limited period)
See also: Visual abstract
Commentary on Twitter
Among adults with cancer and VTE, direct oral anticoagulants were noninferior to low-molecular-weight heparin for preventing recurrent VTE over 6-month follow-up. #ASCO23 https://t.co/DP5RvlSYxe pic.twitter.com/rBJ99plopK
— JAMA (@JAMA_current) June 2, 2023
Review | Prevention of venous thromboembolism in patients with cancer
5 Jun, 2023 | 13:48h | UTCPrevention of venous thromboembolism in patients with cancer – The BMJ
M-A | Hypoxia-inducible factor stabilizers’ effects on lab parameters and outcomes in CKD patients with renal anemia
5 Jun, 2023 | 13:00h | UTC
ASH 2023 Guidelines for management of venous thromboembolism | Thrombophilia testing
1 Jun, 2023 | 12:22h | UTC
Cardiac toxicities in multiple myeloma: an updated and a deeper look into the effect of different medications and novel therapies
1 Jun, 2023 | 11:48h | UTC
RCT | Prophylactic platelet transfusion reduces CVC-related bleeding in patients with platelets 10-50 K/mm³
31 May, 2023 | 14:20h | UTCPlatelet Transfusion before CVC Placement in Patients with Thrombocytopenia – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary on Twitter
Withholding of prophylactic platelet transfusion before CVC placement in pts with a platelet count of 10,000 to 50,000 per cubic millimeter did not meet the predefined margin for noninferiority & resulted in more CVC-related bleeding events than prophylactic platelet transfusion.
— NEJM (@NEJM) May 27, 2023
RCT | Early initiation of DOACs not statistically superior to later use in atrial fibrillation-related stroke
31 May, 2023 | 14:17h | UTCEarly versus Later Anticoagulation for Stroke with Atrial Fibrillation – New England Journal of Medicine (link to abstract – $ for full-text)
Commentaries:
ELAN: Early DOACs Safe, May Help After Ischemic Stroke in AF Patients – TCTMD
Commentary on Twitter
Late breaking at #ESOC2023: In the ELAN trial, the estimated incidence of stroke, systemic embolism, hemorrhage, or death was 2.8 percentage points lower to 0.5 percentage points higher with early than with later use of direct oral anticoagulants. Full results:
— NEJM (@NEJM) May 24, 2023
Review | How to approach acute thrombosis and thrombocytopenia
31 May, 2023 | 14:03h | UTCHow to approach acute thrombosis and thrombocytopenia – Clinical Medicine Journal
Current guidelines for perioperative management and transfusion decisions in sickle cell patients
30 May, 2023 | 11:57h | UTC
Cohort Study | Amiodarone linked to higher bleeding risk vs. flecainide or sotalol in atrial fibrillation patients on anticoagulants
30 May, 2023 | 12:01h | UTCRisk for Bleeding-Related Hospitalizations During Use of Amiodarone With Apixaban or Rivaroxaban in Patients With Atrial Fibrillation: A Retrospective Cohort Study – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentary on Twitter
A study of older adults with #AFib who were treated with #anticoagulants found #amiodarone during apixaban/rivaroxaban use was associated with greater risk for bleeding-related #hospitalizations compared to flecainide or sotalol: https://t.co/cFb1rgGqjt pic.twitter.com/gKlgLXBdb2
— Annals of Int Med (@AnnalsofIM) May 25, 2023
Guideline | Investigation and management of acute transfusion reactions
29 May, 2023 | 11:02h | UTC
RCT | Apixaban fails to match warfarin in preventing valve thrombosis in On-X mechanical heart valve patients
22 May, 2023 | 13:44h | UTCApixaban or Warfarin in Patients with an On-X Mechanical Aortic Valve – NEJM Evidence
Commentary: Apixaban or Warfarin in Patients With On-X Mechanical Aortic Valve – American College of Cardiology
Commentary on Twitter
“…in patients with an On-X mechanical aortic valve, apixaban was not noninferior to warfarin and failed to meet our safety threshold… for the prevention of valve thrombosis or valve-related thromboembolism.” https://t.co/XEcOJiGIYU#CardioTwitter #Afib
— NEJM Evidence (@NEJMEvidence) May 11, 2023
RCT | Ruxolitinib achieves greater molecular response and EFS in hydroxycarbamide-resistant Polycythemia Vera
22 May, 2023 | 13:35h | UTCCommentary: Ruxolitinib Appears to Yields Superior Responses in Polycythemia Vera Subtype – Cancer Network
RCT | Superior progression-free survival with Venetoclax-based regimens in first-line CLL treatment
22 May, 2023 | 13:32h | UTCFirst-Line Venetoclax Combinations in Chronic Lymphocytic Leukemia – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: First-Line Venetoclax Combinations vs Chemoimmunotherapy in Fit Patients With CLL – The ASCO Post
Commentary on Twitter
Venetoclax with obinutuzumab or rituximab as first-line treatment for pts with CLL & coexisting conditions has resulted in a large percentage of pts with undetectable minimal residual disease & long progression-free survival.
Read the Research Summary: https://t.co/2i45QN55Hz
— NEJM (@NEJM) May 14, 2023
RCT | The addition of Quizartinib to chemotherapy improves overall survival vs placebo in FLT3-ITD-positive AML patients
18 May, 2023 | 13:40h | UTCQuizartinib plus chemotherapy in newly diagnosed patients with FLT3-internal-tandem-duplication-positive acute myeloid leukaemia (QuANTUM-First): a randomised, double-blind, placebo-controlled, phase 3 trial – The Lancet (link to abstract – $ for full-text)
Commentary on Twitter (thread – click for more)
Acute myeloid leukaemia (AML) is a genetically heterogeneous disease with poor clinical outcomes.
A new study assessed the effect of quizartinib on overall survival in patients with FLT3-ITD-positive newly diagnosed AML, in addition to chemotherapy. https://t.co/MGOoVF5QOa
— The Lancet (@TheLancet) April 27, 2023
Phase 2 RCT | Ropeginterferon shows better results in hematocrit control vs phlebotomy alone in patients withr polycythemia vera
18 May, 2023 | 13:37h | UTCRopeginterferon versus Standard Therapy for Low-Risk Patients with Polycythemia Vera – NEJM Evidence
RCT | Motixafortide and G-CSF to mobilize hematopoietic stem cells for autologous transplantation in multiple myeloma
16 May, 2023 | 14:48h | UTCNews Release: Investigational drug may improve stem cell transplantation for multiple myeloma patients – Washington University in St. Louis
Commentary on Twitter
A new compound, motixafortide, can safely mobilize an optimal number of stem cells for collection and transplantation in over 90% of 80 patients with multiple myeloma with one injection, reports a phase 3 clinical trial published in @NatureMedicine. https://t.co/23bBzCyoor pic.twitter.com/d9DTs4X1cO
— Nature Portfolio (@NaturePortfolio) April 17, 2023
RCT | Bortezomib-Dexamethasone, Rituximab, and Cyclophosphamide for Waldenström’s Macroglobulinemia
16 May, 2023 | 14:24h | UTCBortezomib-Dexamethasone, Rituximab, and Cyclophosphamide as First-Line Treatment for Waldenström’s Macroglobulinemia: A Prospectively Randomized Trial of the European Consortium for Waldenström’s Macroglobulinemia – Journal of Clinical Oncology (link to abstract – $ for full-text)
RCT | Rivaroxaban doesn’t reduce thrombotic events, hospitalization, or death in outpatients with COVID-19
15 May, 2023 | 13:19h | UTCSummary: The PREVENT-HD trial, a double-blind, placebo-controlled randomized study, was conducted to evaluate the effectiveness of prophylactic anticoagulation in reducing venous and arterial thrombosis, hospitalization, and death in nonhospitalized patients with symptomatic COVID-19 and at least one thrombosis risk factor. The trial took place between August 2020 and April 2022 across 14 US integrated healthcare delivery networks, with 1,284 patients enrolled and randomly assigned to receive either 10 mg of oral rivaroxaban or placebo daily for 35 days.
However, the study was terminated prematurely due to enrollment challenges and lower-than-expected event rates. The primary efficacy outcome, a composite of various hazardous events, occurred in 3.4% of the rivaroxaban group and 3.0% of the placebo group, with no significant difference between the two groups (hazard ratio, 1.16 [95% CI, 0.63–2.15]; P=0.63). No critical-site or fatal bleeding was observed, and only one patient in the rivaroxaban group experienced a major bleed.
In conclusion, rivaroxaban prescribed for 35 days in nonhospitalized patients with symptomatic COVID-19 at risk for thrombosis does not appear to reduce the composite end point of venous and arterial thrombotic events, hospitalization, and death. The study’s premature termination and lower-than-expected event rates may limit the generalizability of these findings.
Commentary on Twitter
#OriginalArticle: In this #RCT, Rivaroxaban did not appear to reduce a composite endpoint of venous and arterial thrombotic events, hospitalization, and death among non‐hospitalized patients with symptomatic COVID‐19 #AHAJournals https://t.co/PhdXnTJ0V9 pic.twitter.com/f04uYu2M5f
— Circulation (@CircAHA) May 10, 2023
Therapeutic plasma exchange: Core curriculum 2023
15 May, 2023 | 13:14h | UTCTherapeutic Plasma Exchange: Core Curriculum 2023 – American Journal of Kidney Diseases
Commentary on Twitter
Therapeutic Plasma Exchange: Core Curriculum 2023 https://t.co/6IoHXeAzyO (FREE)@Elena_Cervants @JohnSperati pic.twitter.com/3OVgAhXjCv
— AJKD (@AJKDonline) May 7, 2023
Brief Review | Coagulation support during perioperative bleeding management
15 May, 2023 | 13:01h | UTCCoagulation support during perioperative bleeding management – Intensive Care Medicine
Commentary on Twitter
Coagulation & perioperative bleeding
?fibrinogen source/dose/time
?Ca++: just vs citrated blood products?
?PCCs/factor concentrates
?TXA
?plasma: volume or coagulation?
?PLTs as primary components
?RBCs not just DO2
?targeted coagulation support
?️ https://t.co/lv1i5GoHBg pic.twitter.com/8BtuAE6gt8— Intensive Care Medicine (@yourICM) May 13, 2023
Review | Treatment of amyloidosis: present and future
12 May, 2023 | 13:22h | UTCTreatment of amyloidosis: present and future – European Heart Journal Supplements
See all articles in the series here
Podcast | Hypercoagulable work-up
11 May, 2023 | 11:41h | UTC#391 Hypercoagulable Work-Up with Dr. Jean Connors – The Curbsiders
Consensus Paper | Antithrombotic treatment strategies in patients with established coronary atherosclerotic disease
10 May, 2023 | 15:51h | UTC
RCT | Ibrutinib plus rituximab improve CLL PFS vs chemoimmunotherapy, but increased unexplained/cardiac deaths
8 May, 2023 | 13:00h | UTC