Author: Dr.S.Harsha Vardhan

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Extended Rivaroxaban in Medical Patients Post-Discharge From Hospital Cuts Arterial Events Too

Extended prophylaxis with a low dose of the anticoagulant rivaroxaban (Xarelto, Janssen) in selected medically ill patients being discharged from hospital reduced both venous and arterial thrombotic events, including a 50% reduction in stroke, without significantly increasing bleeding, according to a new analysis of the MARINER trial.

“These results really bring it home that medically ill patients are at risk from arterial thromboembolic events as well as venous thrombotic events in the immediate postdischarge period, and if we use an individualized approach, then extended anticoagulant treatment is beneficial for reducing both venous and arterial events,” lead author Alex C. Spyropoulos, MD, professor of medicine at the Hofstra Northwell School of Medicine, Hempstead, New York, told Medscape Medical News. 

“Our findings have major healthcare implications,” he added. “On a population health basis, use of this therapy in patients selected as having high thrombogenic risk and low bleeding risk could prevent more than 12,000 thrombotic events every year at the cost of less than 3000 major bleeds. That is a very favorable trade-off.” 

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Endothelial Injury May Play a Major Role in COVID-19 Associated Coagulopathy

A striking clinical feature of illness from SARS-CoV-2 is a marked increase in thrombotic and microvascular complications, or COVID-19–associated coagulopathy (CAC).

A new study suggests endothelial cell injury plays a major role in the pathogenesis of CAC, and blood levels of soluble thrombomodulin correlate with mortality.

George Goshua, MD, of Yale University, New Haven, Conn., presented this study as a late-breaking abstract at the virtual annual congress of the European Hematology Association.

Dr. Goshua cited past research showing CAC to be highly prevalent among hospitalized patients. Venous thromboembolism was found in 17% to 69% of patients, despite thromboprophylaxis. Arterial thrombosis has been seen in 3.6% to 4.0% of patients, and autopsy findings have shown microvascular thrombosis in as many as 87% of patients.

For their study, Dr. Goshua and colleagues assessed endothelial cell damage, platelet activation, and hemostatic and fibrinolytic cascade effects of CAC.

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FDA Approves In-Home Breast Cancer Treatment

The US Food and Drug Administration approved a combination of pertuzumab (Perjeta, Genentech/Roche), trastuzumab (Herceptin, Genentech/Roche) and hyaluronidase (Phesgo, Genentech/Roche) that is administered subcutaneously — rather than intravenously — for the treatment of early and metastatic HER2-positive breast cancers.

Phesgo is initially used in combination with chemotherapy at an infusion center but could continue to be administered in a patient’s home by a qualified healthcare professional once chemotherapy is complete, according to the FDA.

Administration takes approximately 8 minutes for the initial loading dose and approximately 5 minutes for maintenance doses, according to a Genentech press statement. This compares favorably to the 150 minutes needed for the combined loading dose of intravenous pertuzumab and trastuzumab, and the 60-150 minutes for IV maintenance infusions, the company said.

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Temporary IVC Filter Reduces Neurosurgery Complications in Thrombophilic Patients

Thrombophilic patients undergoing elective neurosurgery who receive a temporary inferior vena cava (IVC) filter show dramatically fewer thrombotic or hemorrhagic complications compared with thrombophilia patients who do not have the filter placed, results from a randomized trial show.

“The use of a temporary IVC filter in thrombophilic patients that need elective cranial or spinal surgery is safe and statistically significantly lessens pulmonary embolisms, sudden death from saddle pulmonary embolism, and hemorrhagic complications due to early re-anticoagulation,” said Scott Shapiro, MD, Robert J. Campbell professor of neurosurgery at the Indiana University School of Medicine, in Indianapolis.

He presented the findings as part of the virtual American Association of Neurological Surgeons (AANS) 2020 Annual Meeting.

“This is a very easy strategy to implement in this high risk group and I strongly recommend (the) adoption of this approach,” he said.

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