Direct oral anticoagulants or low-molecular-weight heparins for venous thromboembolism in patients with brain tumors - Peeref (2024)

Article Hematology

Treatment and Bleeding Complications of Cancer-Associated Venous Thromboembolism: A Korean Population-Based Study

Sang-A Kim, Ju Hyun Lee, Ji Yun Lee, Hun-Gyu Hwang, Yang-Ki Kim, Ho-Young Yhim, Junshik Hong, Jeong-Ok Lee, Soo-Mee Bang

Summary: This study found that DOACs have become the most prescribed anticoagulant in Korea after five years, but bleeding complications occurred more frequently in CT patients, especially in those treated with DOACs.

Article Medicine, General & Internal

Anti-Xa Activity of Enoxaparin for Prevention of Venous Thromboembolism in Severe Nephrotic Syndrome-A Single Center Prospective Study

Anna Matyjek, Aleksandra Rymarz, Zuzanna Nowicka, Slawomir Literacki, Tomasz Rozmyslowicz, Stanislaw Niemczyk

Summary: The study found that the efficacy of enoxaparin is reduced in severe nephrotic syndrome patients, and the dose should be adjusted based on ideal body weight to achieve target anti-FXa activity.

Article Orthopedics

Comparison of 90-Day Adverse Events Associated With Aspirin and Potent Anticoagulation Use for Venous Thromboembolism Prophylaxis: A Cohort Study of 72,288 Total Knee and 35,142 Total Hip Arthroplasty Patients

Gurpreet Singh, Heather A. Prentice, Benjamin A. Winston, Erik W. Kroger

Summary: This study compared the efficacy and safety of aspirin and potent anticoagulation agents in preventing VTE after TKA and THA. The results showed that aspirin was as effective as LMWH and warfarin in both TKA and THA, and it was also effective in higher-risk patients. However, the noninferiority of aspirin compared to factor Xa inhibitors has not been confirmed.

Article Hematology

Comparative effectiveness and safety of edoxaban, rivaroxaban, and apixaban in patients with venous thromboembolism: A cohort study

Toshiki f*ckasawa, Tomotsugu Seki, Masayuki Nakashima, Koji Kawakami

Summary: This study compared the effectiveness and safety of edoxaban, rivaroxaban, and apixaban in the treatment of venous thromboembolism. The results showed that there were no significant differences among the three drugs in preventing recurrent VTE or in the risk of intracranial hemorrhage or gastrointestinal bleeding.

Article Surgery

A Weight- and Anti-Xa-Guided Enoxaparin Dosing Protocol for venous thromboembolism Prophylaxis in intensive care unit Trauma Patients

Rachel Bigos, Edmond Solomon, Jon D. Dorfman, Michael Ha

Summary: The study evaluated a weight-based and anti-Xa-guided enoxaparin dosing protocol in ICU trauma patients. The protocol was safe and effective in achieving initial anti-Xa levels within goal, but monitoring may be beneficial for patients over 100 kg to prevent sub-prophylactic levels.

Review Oncology

Venous Thrombotic Events and Anticoagulation in Brain Tumor Patients

Maria Diaz, Jasmin Jo

Summary: Brain tumor patients have a higher risk of VTE, and recent studies have identified new risk factors and molecular mechanisms associated with VTE in these patients. Anticoagulation is necessary for VTE treatment in brain tumor patients, and DOACs may be a feasible option.

Article Oncology

Management of venous thromboembolism in high-grade glioma: Does low molecular weight heparin increase intracranial bleeding risk?

Jasmin Jo, Joseph Donahue, Guneet Sarai, Gina Petroni, David Schiff

Summary: This study aimed to assess the risk of intracranial hemorrhage (ICH) in high-grade glioma (HGG) patients with venous thromboembolism (VTE) on low molecular weight heparin (LMWH). The retrospective matched cohort study found that therapeutic LMWH is not associated with a substantially increased risk of ICH in HGG patients, and the median survival was similar among all three cohorts.

Article Oncology

Treatment of Cancer-Associated Thrombosis: Recent Advances, Unmet Needs, and Future Direction

Tzu-Fei Wang, Alok A. Khorana, Giancarlo Agnelli, Dan Bloomfield, Marc P. Bonaca, Harry R. Buller, Jean M. Connors, Shinya Goto, Zhi-Cheng Jing, Ajay K. Kakkar, Yasser Khder, Gary E. Raskob, Gerald A. Soff, Peter Verhamme, Jeffrey Weitz, Marc Carrier

Summary: Cancer-associated thrombosis, a condition with increasing incidence, has significant morbidity and mortality in cancer patients. Recent advances in its treatment include the use of direct oral anticoagulants (DOACs) which are more convenient and effective than low-molecular-weight heparin (LMWH). However, there are still unmet needs and concerns about bleeding risk, drug-drug interactions, and management of patients with severe renal impairment.

Article Medicine, General & Internal

Anti-factor Xa Activity Is Not Associated With Venous Thromboembolism in Critically Ill Patients Receiving Enoxaparin for Thromboprophylaxis: A Retrospective Observational Study

Christoph Dibiasi, Johannes Gratz, Marion Wiegele, Andreas Baierl, Eva Schaden

Summary: This retrospective observational study found no significant difference in anti-factor Xa activity between patients with and without venous thromboembolism.

Review Surgery

Efficacy and Safety of Anti-Xa-Guided Versus Fixed Dosing of Low Molecular Weight Heparin for Prevention of Venous Thromboembolism in Trauma Patients A Systematic Review and Meta-Analysis

Alexandre Tran, Shannon M. Fernando, Rebecca S. Gates, Jacob R. Gillen, Molly E. Droege, Marc Carrier, Kenji Inaba, Elliott R. Haut, Bryan Cotton, Amanda Teichman, Paul T. Engels, Rakesh V. Patel, Jacinthe Lampron, Bram Rochwerg

Summary: This study compared anti-Xa-guided dosing with fixed dosing of low molecular weight heparin (LMWH) for VTE prevention in adult trauma patients. The findings suggest that anti-Xa-guided dosing may reduce the risk of deep vein thrombosis, pulmonary embolism, and any VTE, although the certainty of evidence is low. The impact on mortality and bleeding events remains uncertain. Overall rating: 8 out of 10.

Article Surgery

Impact of Weight on Anti-Xa Attainment in High-Risk Trauma Patients on Enoxaparin Chemoprophylaxis

Julie Elizabeth Farrar, Molly Elizabeth Droege, Carolyn Dosen Philpott, Eric William Mueller, Neil Edward Ernst, Amy Teres Makley, Kaley Marie Deichstetter, Christopher Allen Droege

Summary: This study found that trauma patients with higher subprophylactic anti-Xa concentrations had higher total body weight and lower weight-adjusted enoxaparin dose. However, these factors did not result in differences in the incidence of VTE or red blood cell transfusions.

Article Anesthesiology

Low molecular weight heparin for venous thromboembolism prophylaxis in general Intensive Care Unit patients: an anti-factor Xa level-based approach

Nitzan Zohar, Martin H. Ellis, Sara Dichtwald, Avraham Meyer, Edna Zohar, Nisim Ifrach

Summary: This study aimed to determine the proportion of acutely ill patients in a general ICU receiving standard VTE prophylaxis that achieve adequate peak or trough anti-FXa prophylactic levels and to determine the effect of LMWH dose adjustment in patients not achieving adequate anti-FXa prophylactic levels. The results showed that most ICU patients did not achieve recommended prophylactic anti-FXa levels while receiving a standard dose of enoxaparin and these levels failed to increase after enoxaparin dose escalation in a significant proportion of patients. High BMI and male gender are associated with sub-prophylactic levels of anti-FXa in critically ill patients.

Article Orthopedics

The risk of venous thromboembolism in surgically treated hip fracture: A retrospective cohort study of 5184 patients

Philippe Beauchamp-Chalifour, Etienne L. Belzile, Reinemary Michael, Valerie Langevin, Noemie Gaudreau, Nicolas Normandeau, Luc Bedard, Stephane Pelet

Summary: Elderly patients undergoing surgery for a hip fracture have a higher risk of venous thromboembolism than previously estimated, and the associated bleeding events are mainly hematomas. Future research should focus on the management of thromboprophylaxis in this population.

Review Hematology

Achieving higher efficacy without compromising safety with factor XI inhibitors versus low molecular weight heparin for the prevention of venous thromboembolism in major orthopedic surgery-Systematic review and meta-analysis

Joao Presume, Jorge Ferreira, Regina Ribeiras, Miguel Mendes

Summary: This study systematically evaluated the use of FXI inhibitors in major orthopedic surgery and found that FXI inhibitors significantly reduced the incidence of venous thromboembolism and bleeding events among patients.

Review Hematology

Prophylaxis of Venous Thromboembolism in Children: A Systematic Review

Lotte Hejberg Pedersen, Gitte Bonde Villadsen, Maja Hellfritzsch, Anne-Mette Hvas

Summary: Venous thromboembolism (VTE) in children is a rare but serious event. Current guidance on pharmacological thromboprophylaxis in children is mostly based on adult studies and expert opinions. This systematic review found that only children with multiple risk factors for VTE are likely to benefit from pharmacological thromboprophylaxis.

Article Hematology

Adhesive properties of plasma-circulating and platelet-derived microvesicles from healthy individuals

E. O. Artemenko, S. I. Obydennyi, K. S. Troyanova, G. A. Novichkova, D. Y. Nechipurenko, M. A. Panteleev

Summary: In this study, we investigated the adhesive properties of circulating plasma-derived and platelet-derived microvesicles (MVs) and their potential role in thrombus growth. The results showed that both types of MVs weakly bound fibrinogen but did not stably adhere to immobilized fibrinogen. Moreover, the presence of these MVs did not significantly affect thrombus formation. Therefore, MVs present in the plasma of healthy individuals are unlikely to directly contribute to thrombus formation under arterial flow conditions.

Letter Hematology

Recent monthly mortality for pulmonary embolism in the US

Giuseppe Lippi, Camilla Mattiuzzi, Emmanuel J. Favaloro

Article Hematology

Exploration of rotational thromboelastometry (ROTEM) to characterize the coagulation profiles of newly diagnosed pediatric leukemia patients

Marium Malik, Maha Al-Ghafry, Abraham Haimed, Julia Su, Maribel Lema, Linda Shore-Lessersson, Suchitra S. Acharya

Summary: This study analyzed and evaluated leukemia-associated coagulopathy in newly diagnosed pediatric leukemia patients using CCTs and ROTEM. The results showed that fibrinogen and platelets played a significant role in causing coagulopathies in this population. This suggests the utility of using CCTs and ROTEM in the pediatric population to evaluate hemostatic function and guide blood product replacement.

Review Hematology

Thrombotic triad in microgravity

Mohammad M. Elahi, Alexandra N. Witt, Edward L. G. Pryzdial, Paul B. McBeth

Summary: Thrombotic disease may be underdiagnosed in microgravity conditions, and the underlying factors are still poorly understood. A case of internal jugular vein thrombosis was recently diagnosed in a low-risk female astronaut, and six out of ten additional crew members showed risk factors for jugular venous flow. Observations in space and studies on Earth suggest that microgravity affects blood flow, coagulation, and vascular function.

Review Hematology

Comparison of important factors to patients recovering from pulmonary embolism and items covered in patient-reported outcome measures: A mixed-methods systematic review

Stian Ingemann-Molden, Christina Krogner Caspersen, Nanna Rolving, Anette Arbjerg Hojen, Frederikus A. Klok, Erik L. Grove, Barbara Cristina Brocki, Jane Andreasen

Summary: This study found that no single PROM covered all aspects considered important by PE patients. PROMs recommended in the ICHOM core set covered most aspects, but worrisome thoughts, hypervigilance around symptoms, and uncertainty of illness were not covered.

Article Hematology

Driver gene KRAS aggravates cancer-associated stroke outcomes

Haomin Yan, Tsutomu Sasaki, Yasufumi Gon, Kumiko Nishiyama, Hideaki Kanki, Hideki Mochizuki

Summary: The incidence of cancer-associated stroke has increased with the prolonged survival times of cancer patients. In this study, the researchers focused on the driver gene KRAS and found that KRAS mutations exacerbated neurological deficits after stroke and promoted tumor growth. They also identified the upregulation of pro-inflammatory responses and the promotion of STAT3 phosphorylation in mice with KRAS mutations. Additionally, the researchers found that colorectal cancer patients with stroke onset within 3 months after cancer diagnosis had a worse prognosis.

Letter Hematology

Identification of two de novo variants causing inherited antithrombin deficiency by quantitative analysis of variant alleles

Tomoki Togashi, Satomi Nagaya, Makiko Meguro-Horike, Haruto Matsumoto, Yuta Imai, Koichi Yamaguchi, Yoshinari Fujii, Haruka Moriya, Yuika Kikuchi, Ibuki Yasuda, Shin-ichi Horike, Eriko Morish*ta

Article Hematology

Shock score for prediction of clinical outcomes among stable patients with acute symptomatic pulmonary embolism

Marta Najarro, Winnifer Briceno, Carmen Rodriguez, Alfonso Muriel, Sara Gonzalez, Ana Castillo, Ignacio Jara, Parth Rali, Catalin Toma, Behnood Bikdeli, David Jimenez

Summary: The CPES score is a useful tool in identifying the risk of hemodynamic deterioration in normotensive patients with acute PE, with acceptable C-statistic, excellent specificity, and low positive predictive value.

Article Hematology

Trimethylamine-N-oxide (TMAO) and basic fibroblast growth factor (bFGF) are possibly involved in corticosteroid resistance in adult patients with immune thrombocytopenia

Lei Liu, Huifang Xu, Jian Wang, Haiyan Wang, Saisai Ren, Qian Huang, Mingyan Zhang, Hui Zhou, Chunyan Yang, Lu Jia, Yu Huang, Hao Zhang, Yanling Tao, Ying Li, Yanan Min

Summary: This study investigated the gut microbiota metabolites and cytokines, chemokines, and growth factors in patients with ITP and found their association with treatment responsiveness. The findings suggest that imbalanced secretion of cyto(chemo)kins/growth factors and inadequate levels of TMAO are characteristic of patients with ITP.

Article Hematology

Safety of fixed-dose heparin titration boluses in underweight patients

Roxanne Mcknight, Mohammad Salameh, Lee Ann Jones, Greta Anton, Lindsay Carter

Summary: This study evaluated the safety of fixed-dose heparin titration boluses in underweight patients with VTE. The results showed that although underweight patients required more frequent holding of heparin, there was no significant increase in bleeding risk.