General Hematology
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 | 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
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
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 | UTCNews Release: Landmark Malawi trial boosts iron levels in pregnant women – Walter and Eliza Hall Institute of Medical Research
Commentary from the author on Twitter
Very excited to announce the publication of our clinical trial – REVAMP – in @TheLancet: https://t.co/Zpd9500u6b. We evaluated intravenous iron vs oral iron's efficacy and safety in recovering anaemia in Malawian pregnant women. Check out this thread to learn what we found👇 pic.twitter.com/que9hefUhM
— Ricardo Ataide (@ricardoataide) April 24, 2023
Cohort Study | Idiopathic CD4 Lymphocytopenia linked to increased infection risk and cancer prevalence
5 May, 2023 | 15:16h | UTCReappraisal of Idiopathic CD4 Lymphocytopenia at 30 Years – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary on Twitter
Idiopathic CD4 lymphocytopenia was initially described approximately 30 years ago as #HIV infections were emerging. In this report, longer-term characteristics of this syndrome are described. https://t.co/kV45SKmRQv#InfectiousDisease
— NEJM (@NEJM) May 3, 2023
Review | Heparin-induced thrombocytopenia
5 May, 2023 | 15:01h | UTCHeparin-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 | UTCDirect 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
Direct Oral Anticoagulants versus Warfarin Across the Spectrum of Kidney Function: Patient-Level Network Meta-Analyses from COMBINE AF @jlharrington_md #AHAJournals https://t.co/6Rzlt09m9W pic.twitter.com/2oknvnken8
— Circulation (@CircAHA) April 18, 2023
Scientific Statement | Iron deficiency in heart failure
3 May, 2023 | 15:25h | UTC
Clinical practice guidelines on hemochromatosis
3 May, 2023 | 15:23h | UTC
ASCO Guideline Update | Venous thromboembolism prophylaxis and treatment in patients with cancer
25 Apr, 2023 | 14:49h | UTC
RCT | Blood donor’s sex does not impact transfusion recipients’ survival
19 Apr, 2023 | 13:20h | UTCEffect 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
Observational data are conflicting about whether donor sex influences mortality among transfusion recipients. In a multicenter trial in Canada involving 8719 patients, mortality was not influenced by blood-donor sex. https://t.co/54GKPXSXES pic.twitter.com/uYw1KT15py
— NEJM (@NEJM) April 12, 2023
Phase 2 RCT | Dersimelagon in erythropoietic protoporphyrias
17 Apr, 2023 | 13:05h | UTCDersimelagon in Erythropoietic Protoporphyrias – News England Journal of Medicine (link to abstract – $ for full-text)
Commentary on Twitter
In a phase 2 trial, once-daily oral treatment with dersimelagon safely improved tolerance to sun exposure in patients with erythropoietic protoporphyria and X-linked protoporphyria. https://t.co/peZye8R5T7 pic.twitter.com/DO2HmKkM1f
— NEJM (@NEJM) April 12, 2023
M-A | Efficacy of postpartum pharmacologic thromboprophylaxis
17 Apr, 2023 | 12:55h | UTC
RCT | Hydroxyurea for secondary stroke prevention in children with sickle cell anemia
17 Apr, 2023 | 12:48h | UTC
Review | Inappropriate prescriptions of direct oral anticoagulants (DOACs) in hospitalized patients
12 Apr, 2023 | 13:14h | UTC
Review | Anticoagulation in patients with liver cirrhosis: friend or foe?
11 Apr, 2023 | 14:17h | UTCAnticoagulation 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 | UTCNews 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
Commentary on Twitter
Neutropenia diagnosis & management were previously based on physicians' experience or local practices. To harmonize #hematology treatment, #EHA & @eunet_innochron have published a new #EHAGuideline on #neutropenia in adults & children in @Hemasphere_EHA: https://t.co/ifYEtzNlAv pic.twitter.com/CnKuqG03Up
— European Hematology Association (@EHA_Hematology) April 3, 2023
Hydroxyurea use in youths with sickle cell anemia: underused despite updated 2014 guidelines
5 Apr, 2023 | 13:16h | UTCOriginal Guideline: National Heart, Lung, and Blood Institute. Evidence-based management of sickle cell disease: expert panel report, 2014
Commentary on Twitter
Hydroxyurea prescribing in youths with sickle cell anemia insured by Medicaid modestly after the @nih_nhlbi guidelines recommended hydroxurea in 2014. Increasing hydroxyurea use may require a multifaceted approach. https://t.co/tkY0HiMvkv
— JAMA Network Open (@JAMANetworkOpen) March 24, 2023
RCTs | Fitusiran prophylaxis reduces bleeding in people with hemophilia A or hemophilia B
3 Apr, 2023 | 13:44h | UTCEfficacy 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
Study shows increased bleeding complications in ESKD patients undergoing AF ablation
24 Mar, 2023 | 13:09h | UTCSummary: 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.
Commentary on Twitter
Peri-procedural anticoagulation in patients with end-stage kidney disease undergoing #afib ablation 👉 despite undertreatment with warfarin, the rate of haemorrhagic complications is high! https://t.co/3W8gEtZYdy#kidney #afib #anticoagulation #ablation #cardiotwitter #europace pic.twitter.com/vI27UeIpRf
— European Society of Cardiology Journals (@ESC_Journals) March 16, 2023
RCT | 4F-PCC fails to reduce blood product consumption and raises thromboembolic events in trauma patients
22 Mar, 2023 | 13:41h | UTCSummary: 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
