Apixaban pips warfarin in extended use comparison

Extended-duration treatment with apixaban beyond 90 days significantly reduces hospitalisation for recurrent VTE rates compared to warfarin (HR 0.69).

A retrospective cohort study of 64,642 patients previously hospitalised for VTE compared outcomes for those on apixaban, rivaroxaban and warfarin.

The study found no difference in subsequent hospitalisation rates for recurrent VTE with rivaroxaban compared to warfarin (HR 0.87) or apixaban compared to rivaroxaban (HR 0.80).

There were no significant differences in rates of hospitalisation for major bleeding or all-cause mortality.

“Results from this investigation provide some evidence that extending treatment after 90 days with apixaban vs warfarin may be beneficial,” it said.

“More data are needed for definitive conclusions about the relative benefits and risks of apixaban compared with rivaroxaban and of rivaroxaban vs warfarin, because this study had limited statistical power to detect small, but clinically important, differences between these treatments.”

Read more in JAMA

More intensive chemo in double-hit lymphoma

DA-EPOCH-R is a well-tolerated outpatient regimen for people with double-hit lymphoma (DHL) and should be considered for initial treatment in medically fit patients, Australian clinicians say.

A review of 13 patients with DHL treated with DA-EPOCH-R (dose-adjusted etoposide, prednisolone, vincristine, cyclophosphamide, doxorubicin and rituximab) at the Sunshine Cost University Hospital found that the more intensive chemotherapy regimens provided good outcomes and was acceptable to patients.

The complete response rate was 69% while the median event-free survival and overall survival duration was 61 months (95% CI: 41-86 months) and 64 months (95% CI: 42-86 months) respectively.

One patient discontinued DA-EPOCH-R due to recurrent febrile neutropaenia and there were no treatment or infection-related deaths during the study, reported Dr Ricky Nelles and colleagues in Internal Medicine Journal.

Osteoporosis guidance needed for people with haemophilia

Australian haemophilia guidelines lack clear recommendations for osteoporosis screening, treatment and management in patients with haemophilia, a review has found.

Researchers at Monash University, Melbourne say early diagnosis and treatment of osteoporosis is crucial in patients with haemophilia because fractures lead to significant morbidity and mortality in this patient group. Fracture recovery time is also delayed in patients with haemophilia  because prolonged periods of immobility lead to muscular deconditioning, poorer bone health and increased falls and fracture risk.

However in a review of global guidelines they found there was a lack of research on musculoskeletal health in people with haemophilia. As such there was also little evidence to address questions such as whether reduced thrombin generation, factor VII, factor IX and/or IIA generation deficiency in haemophilia itself, are contributing to low bone mineral density

“Further studies are required to assess the trajectory of bone health in patients with haemophilia, the mechanism of bone loss … and the effectiveness of weight-bearing exercises, interventions for fall prevention, screening programmes, and use of anti-osteoporosis medications in people with haemophilia across the lifecourse,” they wrote in Haemophilia.