Hematology and Oncology

Hct target for Polycythemia Vera

In this trial of 365 patients with polycythemia vera, they were randomized to Hct goals of <45% or 45-50%; after a median of 31 months, the primary end point (time to CV death or major thrombotic event) occurred in 3% of the lower Hct group and 10% of the higher Hct group. The study now defines Hct targets (<45%) for patients with polycythemia vera (abstract).

Restrict transfusions for UGI bleeding

This trial of almost 1,000 patients with acute upper GI bleeding randomized them to a restrictive (Hb<7) or liberal (Hb<9) transfusion strategy. Only 15% of the liberal, and 51% of the restrictive group did not receive a transfusion; 6 week survival was higher in the restrictive group (95% vs 91%), recurrent bleeding was lower (10% vs 16%),  and adverse events were lower (40% vs 48%). A restrictive transfusion strategy should be applied to patients with acute UGI bleed (abstract).

Restrict blood transfusions in AMI

This large systematic review of patients with AMI found blood transfusions were associated with higher risk of mortality and subsequent AMI compared to no transfusion, regardless of baseline, nadir, or change in hemoglobin. As with many other conditions, the use of blood transfusions should be minimized in patients with AMI (abstract).

Can RBC transfusions worsen UGI bleeding?

This large retrospective database analysis of patients with non-variceal UGI bleed found, after adjusting for confounders, that those who received transfusions were significantly more likely to rebleed than those that did not receive transfusions (odds ratio 1.8, CI 1.2 to 2.8). As with other conditions, RBC transfusions should only be administered when absolutely necessary, but the exact threshold will need to be further delineated with randomized trials (abstract).

Dabigatran not to used with mechanical valves

The FDA has issued a safety alert to avoid the use of dabigatran in patients with mechanical heart valves; a randomized trial was stopped early, as patients with mechanical heart valves were more likely to experience heart attack, stroke, or valve clot while on dabigatran compared to warfarin (FDA site).