ASH News Daily 2013 - Day 2 - (Page A-6)
Page A-6
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THROMBOSIS
New Kids on the Block: Improvement or Same Old Song and Dance?
BY ANITA RAJASEKHAR, MD, MS,
AND MARC ZUMBERG, MD
n the last few years, several advances
to antithrombotic therapy
have emerged from clinical
trials. The stronghold of warfarin
and low-molecular-weight heparin
(LMWH) in the outpatient management
of venous thromboembolism
(VTE) is being challenged by the
new oral anticoagulants (NOACs).
In rigorous clinical trials, these
agents have proven to be non-inferior
and, in some cases, superior
in efficacy compared with warfarin
or LMWH in the prevention or
treatment of VTE. However, little
is known about specific subgroups
within these large trials or "realworld"
effectiveness and safety of
these drugs.
I
In tomorrow's Oral
Session titled Antithrombotic Therapy:
Clinical Trials, which will be
held at 7:00 a.m. in Room 278-282
in the convention center, presenters
will expound on our knowledge
of these NOACs in specific under-
represented populations and in our
daily clinical practice.
Dr. Gary E. Raskob, University
of Oklahoma Health Sciences Center,
will start off the session with
abstract 211. He will present results
from a subset analysis of the
large global Hokusai trial in which
8,292 patients with acute VTE were
randomized to edoxaban, an oral
factor Xa inhibitor, or warfarin
for long-term anticoagulation. Dr.
Raskob and colleagues specifically
analyzed patients with a history of
cancer or active cancer in whom
long-term LMWH was not planned.
Focusing on a different but similarly
challenging subgroup, Dr.
Sam Schulman, McMaster University,
Hamilton, ON, Canada, will
present abstract 212. He will detail
clinical outcomes of dabigatran according
to renal function to help clinicians
decide whether dose reductions
are warranted in patients with
acute VTE and concomitant renal
impairment, a growing segment
of our clinical practice. Referring
ASH News Daily Authors
Shaji Kumar
Shaji Kumar is a professor of
medicine at Mayo Clinic, Rochester,
where he is a member of the
Dysproteinemia and Transplant
groups in the Division of Hematology.
His clinical and research interests
are in plasma cells disorders,
specifically on the mechanisms of
disease progression in monoclonal
gammopathies, risk stratification,
and development of new therapies
for these disorders. In addition to
the results of recent clinical trials in
myeloma, Dr. Kumar is most looking
forward to the sessions of drug
development. He thinks the power
of the process, the ability to develop
targeted drugs, and the hurdles
involved are being showcased well
at this year's annual meeting.
Anita Rajasekhar
Dr. Rajasekhar is an assistant
professor at the University of Florida
in Gainesville, FL. She is a clinician
and clinical investigator with a
focus on prevention and treatment
of venous thromboembolism. At
this year's annual meeting, Dr. Rajasekhar
is most excited about writing
for ASH News Daily and helping
to disseminate the cutting-edge
information that will be presented
at the Plenary, Education Program,
Scientific, and Poster sessions. She
is also eager to taste test the beignet,
a New Orleans delicacy, for the
first time!
In rigorous clinical trials,
these agents have proven
to be non-inferior and,
in some cases, superior
in efficacy compared
with warfarin or LMWH
in the prevention or
treatment of VTE.
to the study, Dr. Schulman stated,
"While dabigatran is 80 percent renally
cleared, since we are treating
a large, active clot rather than preventing
its occurrence, it is important
to give an effective dose and
not reduce it to 110 mg, which has
not been tested for this indication."
In abstract 213 and 214, Dr. Jan
Mark M. Udden
Dr. Udden is a professor of medicine-hematology/oncology
at Baylor
College of Medicine in Houston,
TX. He is the chief of benign
hematology at Baylor and the chief
of hematology service at Ben Taub
General Hospital. At this year's
meeting, Dr. Udden is looking forward
to the sickle cell Education
Sessions, particularly the session
titled Fresh Ideas for Management
and also Dr. Stuart Orkin's presentation
on hemoglobin switching.
He also plans to take some time out
from the sessions to mosey along
Chartres Street and visit Crescent
City Books.
Marc Zumberg
Dr. Zumberg is an associate professor
of medicine, Section Chief of
Non-Malignant Hematology, and
clinician educator at the University
of Florida, Gainesville, FL. He
has served as a member of the ASH
Committee on Training Programs,
written chapters in ASH-SAP, spoken
at Highlights of ASH®
tributed questions for maintenance
of
certification. For
this
, and conyear's
meeting, he is most excited about
contributing to ASH News Daily,
reconnecting with friends and colleagues,
and eating some great Cajun
food. His main clinical interests
are in all areas of non-malignant
hematology. Please introduce yourself,
should you see him walk by.
Byer-Westendorf, Dresden University
Hospital, Germany, will speak
to real-life efficacy and safety of the
new oral anticoagulants. Results
are derived from the large prospective
Dresden NOAC Registry designed
to study the management
and outcome of patients receiving
these novel agents in daily practice.
First, Dr. Byer-Westendorf will focus
on the effectiveness, bleeding
and cardiovascular complications,
and treatment discontinuation rates
in an unselected population on rivaroxaban
for stroke prevention in
atrial fibrillation. She will then describe
current practice patterns of
treating NOAC bleeding complications
in daily care.
Another setting in which NOACs
have been approved is for VTE prevention
after total knee (TKA) or hip
arthroplasty (THA). In abstract 215,
Dr. Alejandro Lazo-Langer, University
of Western Ontario, Canada,
will present data from the largest
population-based study that examined
patients receiving LMWH versus
rivaroxaban for VTE prevention
after TKA or THA. Dr. Lazo-Langer
stated that the importance of this
study is that "it provides real-world
data, and its results are in line with
the randomized trials, confirming
that rivaroxaban is as effective as,
if not more than, warfarin with no
increase in major bleeding events."
In keeping with the theme of
VTE prevention, Dr. Maria von
Depka, Werlhof-Institute, Hannover,
Germany, will round out the
session with results from an openlabel
single center study evaluating
antithrombin (AT) concentrate in
pregnant patients with AT deficiency.
Women with AT deficiency and
a history of fetal loss or VTE were
given AT concentrate and LMWH
during their current pregnancy. The
rates of live births and thromboembolic
events will be reported and
may impact our current treatment
paradigm in this challenging clinical
scenario.
Today, with the approval of these
"new kids on the block," several
more options exist for the prevention
and treatment of VTE. Whether
these novel agents ultimately
pan out in the real world remain
to be seen. Check out other programs
focusing on antithrombotic
therapies, such as the Oral Session,
Antithrombotic Therapy: Basic Research
and Cancer Trials, on Monday
at 4:30 p.m. in Room 278-282
and Antithrombotic Therapy: Posters
II and III in Hall E, both in the
convention center.
Dr. Rajasekhar and Dr. Zumberg indicated
no relevant conflicts of interest.
Solution to Hematology Crossword Puzzle from Saturday's paper
ASH NEWS DAILY
Sunday, December 8, 2013
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ASH News Daily 2013 - Day 2
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