Hematology and Oncology

Transfusions in medicare patients

In this large retrospective cohort of medicare patients, almost a third had been transfused within a 10 year period. There were regional variations in transfusion rates, with the highest in the south, and the lowest in the west, that could not be explained by patient variables (abstract)

Rivaroxaban for acute DVT

In this large randomized trial of patients with acute DVT, rivaroxaban (oral Xa inhibitor) was non-inferior to lovenox (bridged to coumadin) in the primary outcome of recurrent DVT, with the same incidence of bleeding. After 6-12 months of treatment, those that continued on rivaroxaban had significantly fewer recurrent DVTs than those that continued on placebo. Rivaroxaban is non-inferior to lovenox/warfarin for acute DVT, and better than placebo for ongoing longer term treatment (abstract). It is not currently FDA approved in the US but is under review.

Drug induced immune thrombocytopenia

Using several sources, researchers identified the top 24 medications causally linked to the development of drug induced thrombocytopenia (other than heparin). This list should be reviewed in patients with new thrombocytopenia, and the drug should be stopped before other agents are considered (drug list)

Anti-coagulants and risk for ED visits

In this large retrospective database analysis, researchers found the risk of hemorrhage-related ED visits were 1.2 per 1000 prescriptions for dual anti-platelet therapy, and 2.5 per 1000 prescriptions for warfarin. The risk of hemorrhage-related hospitalizations for these ED visits was no different between the groups (abstract). This better quantifies the risk of bleeding with these medication choices

Rivaroxaban reduces stroke in Afib

In a news release from the AHA, the ROCKET trial randomized patients with non-valvular Afib to warfarin or rivaroxaban (oral Xa inhibitor). The rate of stroke/emboli was significantly lower in the rivaroxaban group (1.7 vs 2.2 per 100 patient years), with no difference in rates of major bleeding. Rivaroxaban (an oral Xa inhibitor) and Dabigatran (an oral thrombin inhibitor) have both been proven to be at least as effective and safe as warfarin in reducing afib-related stroke (AHA site)
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