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General Hematology

Guideline | Investigation and management of acute transfusion reactions

29 May, 2023 | 11:02h | UTC

Guideline on the investigation and management of acute transfusion reactions – British Journal of Haematology


RCT | Apixaban fails to match warfarin in preventing valve thrombosis in On-X mechanical heart valve patients

22 May, 2023 | 13:44h | UTC

Apixaban 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


RCT | Rivaroxaban doesn’t reduce thrombotic events, hospitalization, or death in outpatients with COVID-19

15 May, 2023 | 13:19h | UTC

Summary: 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.

Article: Rivaroxaban for Prevention of Thrombotic Events, Hospitalization, and Death in Outpatients With COVID-19: A Randomized Clinical Trial – Circulation


Commentary on Twitter


Brief Review | Coagulation support during perioperative bleeding management

15 May, 2023 | 13:01h | UTC

Coagulation support during perioperative bleeding management – Intensive Care Medicine


Commentary on Twitter


Podcast | Hypercoagulable work-up

11 May, 2023 | 11:41h | UTC

#391 Hypercoagulable Work-Up with Dr. Jean Connors – The Curbsiders


RCT | Single-dose intravenous iron not superior to oral iron for pregnancy anemia

8 May, 2023 | 12:52h | UTC

Ferric carboxymaltose versus standard-of-care oral iron to treat second-trimester anaemia in Malawian pregnant women: a randomised controlled trial – The Lancet

News Release: Landmark Malawi trial boosts iron levels in pregnant women – Walter and Eliza Hall Institute of Medical Research


Commentary from the author on Twitter


Cohort Study | Idiopathic CD4 Lymphocytopenia linked to increased infection risk and cancer prevalence

5 May, 2023 | 15:16h | UTC

Reappraisal of Idiopathic CD4 Lymphocytopenia at 30 Years – New England Journal of Medicine (link to abstract – $ for full-text)


Commentary on Twitter


Review | Heparin-induced thrombocytopenia

5 May, 2023 | 15:01h | UTC

Heparin-Induced Thrombocytopaenia – ICU Management & Practice


M-A | Direct oral anticoagulants versus warfarin across the spectrum of kidney function in patients with AF

3 May, 2023 | 15:32h | UTC

Direct Oral Anticoagulants Versus Warfarin Across the Spectrum of Kidney Function: Patient-Level Network Meta-Analyses From COMBINE AF – Circulation (free for a limited period)


Commentary on Twitter


Scientific Statement | Iron deficiency in heart failure

3 May, 2023 | 15:25h | UTC

Iron Deficiency in Heart Failure: A Scientific Statement from the Heart Failure Society of America – Journal of Cardiac Failure


Clinical practice guidelines on hemochromatosis

3 May, 2023 | 15:23h | UTC

Clinical practice guidelines on hemochromatosis: Asian Pacific Association for the Study of the Liver – Hepatology International


ASCO Guideline Update | Venous thromboembolism prophylaxis and treatment in patients with cancer

25 Apr, 2023 | 14:49h | UTC

Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Guideline Update – Journal of Clinical Oncology

Commentary: ASCO Updates Guideline on Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer – ASCO Daily News


RCT | Blood donor’s sex does not impact transfusion recipients’ survival

19 Apr, 2023 | 13:20h | UTC

Effect of Donor Sex on Recipient Mortality in Transfusion – New England Journal of Medicine (link to abstract – $ for full-text)

News release: Sex of blood donor has no effect on recipient survival – Ottawa Hospital


Commentary on Twitter


Phase 2 RCT | Dersimelagon in erythropoietic protoporphyrias

17 Apr, 2023 | 13:05h | UTC

Dersimelagon in Erythropoietic Protoporphyrias – News England Journal of Medicine (link to abstract – $ for full-text)


Commentary on Twitter


M-A | Efficacy of postpartum pharmacologic thromboprophylaxis

17 Apr, 2023 | 12:55h | UTC

Efficacy of Postpartum Pharmacologic Thromboprophylaxis: A Systematic Review and Meta-analysis – Obstetrics and Gynecology


RCT | Hydroxyurea for secondary stroke prevention in children with sickle cell anemia

17 Apr, 2023 | 12:48h | UTC

Hydroxyurea for secondary stroke prevention in children with sickle cell anemia in Nigeria: a randomized controlled trial – Blood


Review | Inappropriate prescriptions of direct oral anticoagulants (DOACs) in hospitalized patients

12 Apr, 2023 | 13:14h | UTC

Inappropriate prescriptions of direct oral anticoagulants (DOACs) in hospitalized patients: A narrative review – Thrombosis Research


Review | Anticoagulation in patients with liver cirrhosis: friend or foe?

11 Apr, 2023 | 14:17h | UTC

Anticoagulation in Patients with Liver Cirrhosis: Friend or Foe? – Digestive Diseases and Sciences


Cohort Study | Antiphospholipid antibodies’ prevalence & link to cardiovascular events

10 Apr, 2023 | 13:59h | UTC

Prevalence of Antiphospholipid Antibodies and Association With Incident Cardiovascular Events – JAMA Network Open

News Release: Antiphospholipid antibodies may increase heart disease risk in healthy people – Michigan Medicine


Guidelines on diagnosis and management of chronic neutropenia in adults and children

10 Apr, 2023 | 13:25h | UTC

The European Guidelines on Diagnosis and Management of Neutropenia in Adults and Children: A Consensus Between the European Hematology Association and the EuNet-INNOCHRON COST Action – HemaSphere


Commentary on Twitter


Hydroxyurea use in youths with sickle cell anemia: underused despite updated 2014 guidelines

5 Apr, 2023 | 13:16h | UTC

Changes in Hydroxyurea Use Among Youths Enrolled in Medicaid With Sickle Cell Anemia After 2014 Revision of Clinical Guidelines – JAMA Network Open

Original Guideline: National Heart, Lung, and Blood Institute. Evidence-based management of sickle cell disease: expert panel report, 2014


Commentary on Twitter


RCTs | Fitusiran prophylaxis reduces bleeding in people with hemophilia A or hemophilia B

3 Apr, 2023 | 13:44h | UTC

Efficacy and safety of fitusiran prophylaxis in people with haemophilia A or haemophilia B with inhibitors (ATLAS-INH): a multicentre, open-label, randomised phase 3 trial – The Lancet (link to abstract – $ for full-text)

Fitusiran prophylaxis in people with severe haemophilia A or haemophilia B without inhibitors (ATLAS-A/B): a multicentre, open-label, randomised, phase 3 trial – The Lancet Haematology (link to abstract – $ for full-text)

News Release: Monthly injections of fitusiran reduces bleeds in patients with haemophilia A and B – The Lancet


Position Paper | Prehospital hemorrhage control and treatment by clinicians

27 Mar, 2023 | 13:20h | UTC

Prehospital Hemorrhage Control and Treatment by Clinicians: A Joint Position Statement – Prehospital Emergency Care


Study shows increased bleeding complications in ESKD patients undergoing AF ablation

24 Mar, 2023 | 13:09h | UTC

Summary: The study analyzed 347 procedures in 307 patients with end-stage kidney disease (ESKD) undergoing atrial fibrillation (AF) catheter ablation in 12 referral centers in Japan.

Despite a vast majority of patients having subtherapeutic international normalized ratio (INR) values during the peri-procedural period, 35 patients (10%) experienced major complications, with the majority being major bleeding events (19 patients; 5.4%), including 11 cases of cardiac tamponade (3.2%). There were also two peri-procedural deaths (0.6%), both related to bleeding events. A pre-procedural INR value of 2.0 or higher was identified as the only independent predictor of major bleeding.

Current peri-procedural anticoagulation guidelines state that patients undergoing AF ablation should be under therapeutic anticoagulation throughout the peri-procedural period. The findings of this study suggest that these guidelines may not be appropriate for ESKD patients undergoing the procedure, and the role of peri-procedural anticoagulation in this population should be further investigated.

Article: Peri-procedural anticoagulation in patients with end-stage kidney disease undergoing atrial fibrillation ablation: results from the multicentre end-stage kidney disease–atrial fibrillation ablation registry – EP Europace


Commentary on Twitter


RCT | 4F-PCC fails to reduce blood product consumption and raises thromboembolic events in trauma patients

22 Mar, 2023 | 13:41h | UTC

Summary: The PROCOAG Randomized Clinical Trial aimed to investigate the efficacy and safety of 4-factor prothrombin complex concentrate (4F-PCC) in trauma patients at risk of massive transfusion. Conducted in 12 French trauma centers, this double-blind, randomized, placebo-controlled superiority trial involved 324 patients. All patients were treated according to European traumatic hemorrhage guidelines and received early ratio-based transfusion (packed red blood cells:fresh frozen plasma ratio of 1:1 to 2:1). The primary outcome measured was 24-hour blood product consumption (efficacy), while arterial or venous thromboembolic events were assessed as a secondary outcome (safety).

The trial revealed no significant difference in 24-hour blood product consumption between the 4F-PCC and placebo groups, with median consumption of 12 units and 11 units, respectively. However, the study identified a statistically significant higher risk of thromboembolic events in the 4F-PCC group, with 35% of patients experiencing at least one event compared to 24% in the placebo group.

In conclusion, the study found no beneficial effect of incorporating 4F-PCC into a ratio-based transfusion strategy for patients with severe trauma at risk of massive transfusion. Furthermore, the higher rate of thromboembolic events in the 4F-PCC group indicated potential harm. The findings do not support the routine use of 4F-PCC in patients experiencing trauma who are at risk for extensive transfusion.

Article: Efficacy and Safety of Early Administration of 4-Factor Prothrombin Complex Concentrate in Patients With Trauma at Risk of Massive Transfusion: The PROCOAG Randomized Clinical Trial – JAMA (free for a limited period)

See also: Visual Abstract


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