General Hematology
Nested Case-Control Study: Increased risk of major bleeding in atrial fibrillation patients with concomitant SSRI and oral anticoagulant use
23 Mar, 2024 | 20:48h | UTCStudy Design and Population
This nested case-control study investigated the association between the concomitant use of selective serotonin reuptake inhibitors (SSRIs) and oral anticoagulants (OACs) on the risk of major bleeding among patients with atrial fibrillation. Conducted within the UK’s Clinical Practice Research Datalink, the study included 42,190 cases of major bleeding matched to 1,156,641 controls based on age, sex, cohort entry date, and follow-up duration. Patients initiating OACs between January 2, 1998, and March 29, 2021, were included, with risk-set sampling utilized for control selection.
Main Findings
The study found that concomitant use of SSRIs and OACs was associated with a 33% increased risk of major bleeding compared to OAC use alone, with the highest risk observed within the first 30 days of concurrent use. The increased risk was consistent across different ages, sexes, and patient histories, including those with chronic kidney disease or previous bleeding events. Notably, the elevated risk of bleeding extended up to 6 months of concomitant use but did not vary significantly with the potency of SSRIs or the type of OAC used (direct OACs or vitamin K antagonists).
Implications for Practice
These findings underscore the need for healthcare professionals to closely monitor patients with atrial fibrillation who are prescribed SSRIs in addition to OACs, particularly during the initial months of treatment. This study highlights the importance of managing bleeding risk factors and suggests reconsidering the necessity and duration of concomitant SSRI and OAC use. Future research should focus on strategies to mitigate this bleeding risk and explore alternative treatments for managing depression in patients requiring anticoagulation.
Reference
Phase 2 RCT: Low-dose aspirin significantly reduces hepatic fat in MASLD patients without cirrhosis
20 Mar, 2024 | 17:48h | UTCStudy Design and Population: This phase 2, randomized, double-blind, placebo-controlled clinical trial was carried out over six months at a single hospital in Boston, Massachusetts. The study included 80 participants aged 18 to 70 years diagnosed with metabolic dysfunction–associated steatotic liver disease (MASLD) but without cirrhosis. Participants were randomly assigned to receive either 81 mg of daily aspirin (n=40) or placebo (n=40).
Main Findings: The trial revealed that aspirin significantly reduced the mean absolute change in hepatic fat content by -10.2% compared with placebo, as measured by proton magnetic resonance spectroscopy (MRS), with a statistically significant difference (P=0.009). Furthermore, aspirin treatment notably decreased relative hepatic fat content, increased the proportion of patients achieving a 30% or greater reduction in hepatic fat, and reduced both absolute and relative hepatic fat content as assessed by magnetic resonance imaging proton density fat fraction (MRI-PDFF). Adverse events were mostly minor, with upper respiratory infections and arthralgias being the most common.
Implications for Practice: These findings suggest that low-dose aspirin may be an effective intervention for reducing liver fat in adults with MASLD without cirrhosis, potentially offering a simple, accessible treatment option. However, the results are preliminary and call for further confirmation in larger, more diverse populations. The study underscores the importance of considering low-dose aspirin as part of management strategies for MASLD, pending further research.
Reference
Simon TG et al. (2024). Randomized Clinical Trial: Low-Dose Aspirin Significantly Reduces Hepatic Fat in MASLD Patients Without Cirrhosis. JAMA, 331(11), 920-929. DOI: 10.1001/jama.2024.1215. Access the study here: [Link]
RCT | Restrictive vs. liberal red blood cell transfusion strategy for critically injured patients
11 Aug, 2023 | 15:08h | UTC
NICE Updated Guideline | Venous thromboembolic diseases
7 Aug, 2023 | 15:05h | UTC
Global prevalence, years lived with disability, and trends in anemia burden by severity and cause, 1990–2021
3 Aug, 2023 | 13:43h | UTC
Commentary on Twitter
NEW #GBD study by @IHME_UW on the #anaemia burden by severity and cause, 1990–2021🧵https://t.co/NbiEDSkbGI
Despite a decrease in prevalence, the number of people with anaemia increased globally
In every region females had a higher #anemia YLDs than males pic.twitter.com/oFx4vHRhs1
— The Lancet Haematology (@TheLancetHaem) August 1, 2023
RCT | Ferric derisomaltose plus tranexamic acid may reduce blood transfusion risk by 50% in hip surgery
3 Aug, 2023 | 13:18h | UTCFerric derisomaltose and tranexamic acid, combined or alone, for reducing blood transfusion in patients with hip fracture (the HiFIT trial): a multicentre, 2 × 2 factorial, randomised, double-blind, controlled trial – The Lancet Haematology (link to abstract – $ for full-text)
BSH guideline for anticoagulant management of pregnant individuals with mechanical heart valves
2 Aug, 2023 | 14:01h | UTC
Review | Perioperative iron deficiency anemia
31 Jul, 2023 | 14:02h | UTCPerioperative iron deficiency anaemia – BJA Education
Systematic Review | Monocyte distribution width as a diagnostic marker for infection
26 Jul, 2023 | 13:26h | UTCMonocyte Distribution Width as a Diagnostic Marker for Infection – CHEST
Commentary on Twitter
What is the diagnostic performance of monocyte distribution width across multiple infectious disease outcomes and care settings? Read the full original research in the July issue to learn more: https://t.co/iJxzNwdlgq#JournalCHEST #MedEd #CHESTCritCare pic.twitter.com/epYYOJA9wt
— CHEST® Journal (@journal_CHEST) July 7, 2023
Cohort Study | The role of antiphospholipid syndrome and specific antibodies in predicting SLE pregnancy complications
25 Jul, 2023 | 13:44h | UTCPregnancy outcomes in 1869 pregnancies in a large cohort from the Spanish Society of Rheumatology Lupus Register (RELESSER) – Seminars in Arthritis and Rheumatism (link to abstract – $ for full-text)
Commentary: SLE and Pregnancy Outcomes – RheumNow
Consensus Paper | De-escalation or abbreviation of dual antiplatelet therapy in acute coronary syndromes and PCI
24 Jul, 2023 | 13:08h | UTCDe-escalation or abbreviation of dual antiplatelet therapy in acute coronary syndromes and percutaneous coronary intervention: a Consensus Statement from an international expert panel on coronary thrombosis – Nature Reviews Cardiology (if the link is paywalled, try this one)
Guideline Synopsis | Diagnosis and management of priapism
21 Jul, 2023 | 13:47h | UTCDiagnosis and Management of Priapism – JAMA (free for a limited period)
Original Guideline: The Diagnosis and Management of Recurrent Ischemic Priapism, Priapism in Sickle Cell Patients, and Non-Ischemic Priapism: An AUA/SMSNA Guideline – Journal of Urology
RCT | No definitive benefit of enoxaparin over placebo in preventing VTE in hospitalized older adults
17 Jul, 2023 | 13:57h | UTC
M-A | P2Y12 inhibitors show superior efficacy over aspirin for secondary prevention in CAD
11 Jul, 2023 | 14:06h | UTCP2Y12 Inhibitor or Aspirin Monotherapy for Secondary Prevention of Coronary Events – Journal of the American College of Cardiology (link to abstract – $ for full-text)
Related:
Monotherapy with a P2Y12 inhibitor or aspirin for secondary prevention in patients with established atherosclerosis: a systematic review and meta-analysis – The Lancet (link to abstract – $ for full-text)
Commentary on Twitter
Given superior efficacy & similar overall safety, #P2Y12 inhibitor monotherapy might be preferred over #aspirin monotherapy for long-term secondary prevention in pts w/ established #cvCAD. https://t.co/EehIEuWqOt#JACC #P2Y12i #CardioTwitter @FeliceGragnano @vlgmrc @Drroxmehran pic.twitter.com/betLycXGs5
— JACC Journals (@JACCJournals) July 5, 2023
Review | Hypereosinophilic syndrome (HES) and eosinophilic granulomatosis with polyangiitis (EGPA): two sides of the same coin
7 Jul, 2023 | 16:01h | UTCHES and EGPA: Two Sides of the Same Coin – Mayo Clinic Proceedings
Update on transfusion-related acute lung injury: an overview of its pathogenesis and management
30 Jun, 2023 | 14:31h | UTC
Post hoc analysis | Low-dose aspirin linked to increased risk of anemia in older adults
29 Jun, 2023 | 14:06h | UTCSummary: In a post hoc analysis of the ASPREE randomized controlled trial, the impact of daily low-dose aspirin on anemia, hemoglobin, and serum ferritin concentrations in elderly individuals was investigated. The study included 19,114 community-dwelling individuals aged 70 years and older (or ≥65 years for Black and Hispanic individuals) from Australia and the United States.
Findings reveal an increased incidence of anemia in the aspirin group compared to the placebo group (51.2 events versus 42.9 events per 1000 person-years, respectively). This correlates to a 20% increase in risk (hazard ratio, 1.20 [95% CI, 1.12 to 1.29]). Hemoglobin concentrations displayed a more pronounced decline in the aspirin group by 0.6 g/L per 5 years. Additionally, among participants with ferritin measures, the aspirin group exhibited a greater prevalence of ferritin levels less than 45 µg/L at year 3 and overall decline in ferritin by 11.5%. The study found similar results even in the absence of major bleeding.
This research underscores the risk of anemia and decline in ferritin in otherwise healthy older adults taking low-dose aspirin, highlighting the need for periodic monitoring of hemoglobin levels. However, the study lacked data on the causes of anemia, indicating the need for further research.
Article: Effect of Low-Dose Aspirin Versus Placebo on Incidence of Anemia in the Elderly: A Secondary Analysis of the Aspirin in Reducing Events in the Elderly Trial – Annals of Internal Medicine (link to abstract – $ for full-text)
News Release: Low-dose aspirin may increase anaemia risk in healthy older adults: study – Monash University
Commentaries:
Aspirin Use Ups Risk of Anemia in Elderly Patients: ASPREE – TCTMD
Low-dose aspirin associated with 20% increase in risk of anemia among older adults – ACP Internist
Original Study: Effect of Aspirin on All-Cause Mortality in the Healthy Elderly – New England Journal of Medicine
M-A | Prophylactic intravenous tranexamic acid and thromboembolism in non-cardiac surgery
29 Jun, 2023 | 14:03h | UTC
Podcast | Antiplatelets, anticoagulation for coronary artery disease and atrial fibrillation
28 Jun, 2023 | 13:11h | UTC#400 Antiplatelets, Anticoagulation for Coronary Artery Disease and Afib – The Curbsiders
Review | Renal thrombotic microangiopathy
27 Jun, 2023 | 13:34h | UTCRenal Thrombotic Microangiopathy: A Review – American Journal of Kidney Diseases
Commentary on Twitter
Renal Thrombotic Microangiopathy: A Review https://t.co/YabUm18t4q (FREE)@CPQMD @ReichHeather @UofTNephrology pic.twitter.com/Y9rSnuTFBo
— AJKD (@AJKDonline) June 24, 2023
Report | Global, regional, and national prevalence and mortality burden of sickle cell disease, 2000–2021
23 Jun, 2023 | 13:40h | UTCNews Release: Sickle cell disease is 11 times more deadly than previously recorded – Institute for Health Metrics and Evaluation
Commentary on Twitter (thread – click for more)
Ahead of #WorldSickleCellDay #WSCD23 we are publishing the first detailed global estimates on the burden of #sicklecell disease
Read it #openaccess https://t.co/pVlWZ6s1G4
The authors show that mortality linked to #sicklecell disease is higher than previously described🧵 pic.twitter.com/WplWr0gXqJ
— The Lancet Haematology (@TheLancetHaem) June 16, 2023
Review | Nonsurgical management of major hemorrhage
22 Jun, 2023 | 15:16h | UTCNonsurgical management of major hemorrhage – Canadian Medical Association Journal
M-A | Anticoagulation options for continuous renal replacement therapy in critically ill patients
22 Jun, 2023 | 14:54h | UTC
RCT | LMWH does not increase live birth rates in women with thrombophilia and recurrent miscarriage
21 Jun, 2023 | 13:39h | UTCHeparin for women with recurrent miscarriage and inherited thrombophilia (ALIFE2): an international open-label, randomised controlled trial – The Lancet (link to abstract – $ for full-text)
Commentary on Twitter (thread – click for more)
New study: Many women with recurrent miscarriage are tested for inherited thrombophilia. If confirmed positive, daily subcutaneous low-molecular-weight heparin (LMWH) is given.
This is despite an absence of evidence that such treatment is beneficial 🧵 https://t.co/0IuFhvjlZr
— The Lancet (@TheLancet) June 2, 2023
Position statement | Gastrointestinal bleeding and endoscopic procedures in patients on antiplatelet and/or anticoagulant therapy
21 Jun, 2023 | 13:22h | UTCPosition statement from the Indian Society of Gastroenterology, Cardiological Society of India, Indian Academy of Neurology and Vascular Society of India on gastrointestinal bleeding and endoscopic procedures in patients on antiplatelet and/or anticoagulant therapy – Indian Journal of Gastroenterology (if the link is paywalled, try this one)