Pharmacy & Therapeutics - February 2008 - (Page 117)

Acute Venous Thromboembolism continued from page 110 Meeting Highlights: ASH continued from page 113 time of bleeding (P < 0.0001). When we evaluated a subset of patients with cancer, we identified an association with major bleeding (P = 0.0627). No significant differences were observed between the recurrence and non-recurrence groups. In our study, 20 patients (13.3%) experienced a major bleeding event and 21 patients (14%) had a recurrent episode within one year after the initial VTE. In a similar retrospective study, Willey et al. noted that in 2,090 patients with a recent VTE, 224 patients (10.7%) experienced a recurrence, and 122 patients (5.8%) experienced a bleeding event requiring hospitalization.6 We attributed the increased incidence of major bleeding and recurrent episodes to the fact that the mean age of most of our subjects was 67 years. Using multivariate linear models, Willey suggested that coagulation disorders, cardiac events, and cancer were associated with an increased risk of recurrence and were mildly associated with an increased risk of bleeding that warranted hospitalization.6 By contrast, our variables of interest used in the logistic regression models were too highly correlated to identify any independent risk factor for bleeding or re currence. authors attributed discontinuation of therapy to disease progression in 29%; to drug-related adverse events in 7%; and to death in 3%. Forty-two percent of the patients have continued treatment. Most grade 3–4 myelosuppression occurred within the first cycle, with anemia reported in 25%, neutropenia in 39%, and thrombocytopenia in 41%. Nilotinib was generally well tolerated. Rash was the most common nonhematological adverse event, and the incidence of grade 3–4 myelosuppression was less than 1%. Dr. le Coutre indicated that nilotinib was an effective therapeutic option in this advanced CML population. Major CyR rates have continued to increase with longer follow-up periods without changes in the safety profile, he added. REFERENCE 1. Malcovati L, Porta MG, Pascutto C, et al. Prognostic factors and life expectancy in myelodysplastic syndromes classified according to WHO criteria: A basis for clinical decision making. J Clin Oncol 2005;23:7594–7603. I STUDY LIMITATIONS Our study consisted of a retrospective chart review in a relatively small population. As a result, our findings lacked a causal relationship; they showed only an association between factors. Because most of our subjects were elderly men, we could not extrapolate our findings to the general population. CONCLUSION The management of VTE at our VA center in Fargo diverged from standardized practice guidelines. Improvements are needed in order to conform to appropriate standards. We recommend that larger randomized, prospective studies be performed to identify independent risk factors for bleeding or recurrence as well as their correlation with patient outcomes. Acknowledgment: The authors thank Curt Doetkott for his assistance with the statistical data analysis. CORRECTION In the December 2007 issue of P&T, two items in the coverage of melanoma in the Meeting Highlights feature on page 680 were incorrect. The name Jesus Gomez-Nararro should have read Jesus Gomez-Navarro; he is an employee of Pfizer. Alexander Eggermont spoke at an ECCO-sponsored press briefing, not at a Pfizer-sponsored satellite symposium. P&T regrets the errors. REFERENCES 1. Heit JA, Silverstein MD, Mohr DN, et al. Predictors of survival after deep vein thrombosis and pulmonary embolism: A population-based, cohort study. Arch Intern Med 1999;159:445–453. 2. Caprini JA, Tapson VF, Hyers TM, et al. Treatment of venous thromboembolism: Adherence to guidelines and impact of physician knowledge, attitudes, and beliefs. J Vasc Surg 2005;42: 726–733. 3. Buller HR, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolism disease. Chest 2004;126:401s–428s. 4. Kearon C, Ginsberg JS, Julian JA, et al. Comparison of fixed-dose weight-adjusted unfractionated heparin and low-molecular-weight heparin for acute treatment of venous thromboembolism. JAMA 2006;296:935–942. 5. Ansell J, Hirsh J, Poller L, et al. The pharmacology and management of the vitamin K antagonists. Chest 2004;126:224s. 6. Willey V, Bullano MF, Hauch O, et al. Management patterns and outcomes of patients with venous thromboembolism in the usual community practice setting. Clin Ther 2004;26:1149–1159. I Vol. 33 No. 2 • February 2008 • P&T® 117

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Pharmacy & Therapeutics - February 2008 Contents Editorial Medication Errors Prescription: Washington The Language of (Forgive Us) Change, As P&T Enters the Digital Age New Drugs/Drug News/New Medical Devices Drug Forecast Use and Outcomes of Antifibrinolytic Therapy in Patients Undergoing Cardiothoracic Surgery at 20 Academic Medical Centers in the United States Evaluation of the Management of Acute Venous Thromboembolism and Its Outcomes: One Institution's Experience American Society of Hematology, 49th Annual Meeting Pharmaceutical Approval Update

Pharmacy & Therapeutics - February 2008

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