COVID-19 vaccination guidance for people with bleeding disorders
People with bleeding disorders are recommended to have the COVID-19 vaccine, but may need to treatment to avoid bleeding from an injection site, according to guidance from the Australian Haemophilia Centre Directors’ Organisation (AHCDO). A series of FAQs about COVID-19 vaccination has been published by Haemophilia Foundation Australia based on the AHCDO endorsed COVID-19 vaccination guidance for people with bleeding disorders, produced by the World Federation of Hemophilia (WFH).
The advice is that COVID-19 vaccine is as safe and effective for people with bleeding disorder. However, since the vaccine involves two IM injections, some people with a moderate or severe bleeding disorder, such as haemophilia or VWD or a rare clotting factor deficiency may need to tailor the timing of treatment, for example if they are on prophylaxis with clotting factor concentrate.
New MBS item for RHD NIPT
A new MBS item has been recommended for non-invasive prenatal testing (NIPT) for fetal rhesus D (RHD) genotype in both low-risk women who have not been isoimmunised and high-risk women who have been previously isoimmunised.
In response to an application from the Royal College of Pathologists of Australasia, the Medicare Services Advisory Committee (MSAC) noted that RHD-NIPT was accurate and cost-effective, and is an important test for all RhD-negative pregnant women to have access to. It noted that testing would prevent overtreatment with anti-D Ig, but may be associated with a very small risk of isoimmunisation events in low-risk pregnancies in women with a false negative fetal genotype result.
Currently, Australian Red Cross Lifeblood (Lifeblood) provides RHD NIPT via a temporary funding arrangement for high-risk pregnancies in women sensitised in a previous pregnancy. The new MBS item covers a separate population of women for whom Lifeblood is not funded to provide the testing because they are RhD-negative but not alloimmunised.
Hospitals aren’t helping boost OAC therapy
Oral anticoagulant use in patients with ACS and concomitant AF has improved over time but remains suboptimal, according to an Australian study.
Data from 1,479 patients from the CONCORDANCE and GRACE registries found the likelihood of treatment with anticoagulants increased from 27% in 1999-2000 to 56% in 2016-2017.
The increase appeared driven by higher uptake of DOACs in later years of the study – DOACs comprising 8% of total OAC use in 2014–15 and 35% in 2016–17.
The study found 89% of patients in the group who weren’t receiving oral anticoagulants had a CHA2DS2-VA score >1 for which anticoagulation was indicated.
“Over the 18-year time period of these studies, the proportion of patients discharged on OAC increased from 26% to 61%, closely reflecting the rates of treatment pre-admission,.” the study said.
“Nonetheless, as recently as 2017, almost half of this increasingly prevalent high-risk patient population was not receiving this evidence based therapy.”
The researchers, including senior investigator Professor David Brieger from Concord Hospital, said interventions to bridge the treatment gap had been “disappointingly ineffective”.