Hematology and Oncology

Apixaban reduces VTE recurrence long term

In this large trial of patients with VTE who had already completed 6-12 months of anticoagulation, they were randomized to 12 additional months of apixaban (5 or 10mg bid) versus placebo. Recurrent VTE occurred in 9% of the placebo group, versus 2% of each of the treatment groups. Bleeding occurred in <0.5% of each group. Long term apixaban is effective and safe for reducing recurrent VTE (abstract).

When can we send a PE home from the ED?

This systematic review found evidence from 7 trials that low risk patients with new acute symptomatic PE may be discharged home from the ED; of 741 patients discharged home, none died, 3 had major bleeding, and 13 had a recurrent PE. Some low risk patients can safety be discharged from the ED with acute symptomatic PE (abstract).

IV hydration not beneficial in end stage cancer

In this trial of 129 patients with end stage cancer, they were randomized to IV hydration (1 liter a day) or control (100 cc a day), and found no difference between the groups in symptoms of dehydration, delirium, or fatigue, and no difference in survival. This randomized trial does not support the use of IV hydration in patients with end stage cancer (abstract).

Warfarin bleeding rates in “real world” Afib

This large observational study of ~125,000 patients on warfarin for Afib found the rate of bleeding to be ~4% per person-year (which is higher than rates reported in randomized controlled trials). Bleeding was highest in the first 30 days (12%), and much higher in the first 30 days in those with a CHADS2 score of 4+ (17%). In addition, over 5 years, 9% of patients were admitted for bleeding, and 18% of those died in the hospital, or within 7 days of discharge (abstract).

Warfarin for 6 months after bioprosthetic aortic valves

In this observational cohort of patients s/p bioprosthetic aortic valve surgery, those on warfarin had significantly lower rates of cardiovascular death, stroke, or thromboemboli, compared to those not on warfarin; these benefits persisted up to 6 months after the surgery. Patients appear to benefit from warfarin for 6 months after bioprosthetic aortic valve surgery (abstract).