General Hematology
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)
Review | Traumatic hemorrhage and chain of survival
21 Jun, 2023 | 13:17h | UTC
RCT | Thrice-weekly oral iron shows non-inferiority and fewer gastrointestinal effects in treating iron-deficiency anemia
20 Jun, 2023 | 12:48h | UTCA randomized controlled trial of thrice-weekly versus thrice-daily oral ferrous fumarate treatment in adult patients with iron-deficiency anemia – Ann Hematol (if the link is paywalled, try this one)
RCT | Avapritinib superior to placebo in reducing symptoms, mast-cell burden in indolent systemic mastocytosis patients
20 Jun, 2023 | 12:34h | UTCAvapritinib versus Placebo in Indolent Systemic Mastocytosis – NEJM Evidence
Commentary on Twitter
“…in this 24-week blinded phase of the PIONEER trial, avapritinib demonstrated superiority to placebo in improving symptoms in patients with moderate to severe symptomatic ISM [indolent systemic mastocytosis]….”#Oncology #ClinicalTrials @StanfordDeptMed @ProfMaurer
— NEJM Evidence (@NEJMEvidence) June 15, 2023
Guideline | Screening and diagnosis of significant hemoglobinopathies
20 Jun, 2023 | 12:32h | UTC
M-A | Anticoagulation options for continuous renal replacement therapy in critically ill patients
19 Jun, 2023 | 13:51h | UTC
Systematic Review | Tranexamic acid likely decreases red blood cell transfusion need in hip fracture surgery
16 Jun, 2023 | 14:09h | UTC
RCT | Prehospital use of tranexamic acid in severe trauma cases shows no superiority over placebo
15 Jun, 2023 | 15:16h | UTCPrehospital Tranexamic Acid for Severe Trauma – New England Journal of Medicine (link to abstract – $ for full-text)
News Release: Shining a new light on tranexamic acid for trauma care – Monash University
Commentary on Twitter
Late breaking at #CCR23: In the PATCH-Trauma trial involving adults with major trauma, treatment with tranexamic acid did not result in a greater number of patients surviving with a favorable functional outcome at 6 months than placebo. https://t.co/i8fu34ReCB pic.twitter.com/GEOtRphOBb
— NEJM (@NEJM) June 14, 2023
Review | Acute graft-versus-host disease
14 Jun, 2023 | 14:20h | UTCAcute graft-versus-host disease – Nature Reviews Disease Primers (if the link is paywalled, try this one)
Commentary on Twitter
Tissue damage resulting from allogenic hematopoietic cell transplantation conditioning regimens triggers cellular interactions and #inflammatory cascades that lead to acute #GraftVersusHost disease symptoms https://t.co/iHyUVoV75J pic.twitter.com/ob9X7zQWB8
— Nature Reviews Disease Primers (@DiseasePrimers) June 11, 2023
Brief Review | Resistance to unfractionated heparin in the ICU: evaluation and management options
12 Jun, 2023 | 13:32h | UTCResistance to unfractionated heparin in the ICU: evaluation and management options – Intensive Care Medicine (if the link is paywalled, try this one)
Commentary on Twitter
🩸 Resistance to unfractionated heparin in #ICU, evaluation & management options
💉 monitoring UFH
💉 mechanisms of resistance
💉 how to manage UFH resistance
PS check supplement table on IV anticoagulants in ICU#FOAMcc @JerroldLevy @Dr_Cit @foamecmo
🖇️ https://t.co/ojQw5On5ZL pic.twitter.com/0uPQuwUmOr— Intensive Care Medicine (@yourICM) June 7, 2023
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
ASH 2023 Guidelines for management of venous thromboembolism | Thrombophilia testing
1 Jun, 2023 | 12:22h | 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 | 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