News in brief: DOACs ‘a reasonable option’ for treating cerebral vein thrombosis; Clopidogrel cessation inquest verdict; More specialists are using My Health Record

DOACs ‘a reasonable option’ for treating cerebral vein thrombosis

Direct oral anticoagulants (DOACs) might represent “a reasonable” option for patients with cerebral vein thrombosis (CVT), suggest findings of an analysis published in the British Journal of Haematology.

The review, by researchers in Malta, included 23 studies (RCTs, observational or case reviews) in the MEDLINE, EMBASE and CENTRAL databases, which involved adults with CVT treated with any DOACs (e.g apixaban, dabigatran, edoxaban, rivaroxaban), and either no comparator or an alternative oral anticoagulant, such as low-molecular-weight heparin, fondaparinux or vitamin K agonists (VKAs).

The researchers found no significant differences between patients receiving DOACs and those given VKAs with regard to: mortality (1.76% versus 1.08%, respectively); major bleeding (2.54% versus 2.72%); recurrent thrombosis (2.02% versus 2.01%); excellent neurological outcome (84.9% versus 75.7%); and vessel recanalisation (84.9% versus 85.1%).

The results, they concluded, “suggest that the DOACs, usually started after an initial heparin treatment, are associated with acceptable rates of major bleeding and recurrent VTE on treatment, and high rates of vessel recanalisation and excellent neurological outcomes.”

“In addition, the DOACs seem to have similar safety and efficacy when compared to VKAs, thus representing a reasonable oral anti-coagulant treatment option for CVT patients”.

Clopidogrel cessation inquest verdict

A decision by an anaesthetic team to stop a patient’s clopidogrel and replace it with low-dose aspirin (Cartia) was outside their expertise, and contributed to the death of a man undergoing orthopaedic surgery, an inquest has found.

The NSW coroner heard that the 55-year-old man had previously had mesenteric stents inserted, and these became occluded by thrombosis after he was taken off clopidogrel therapy at the Fairfield pre-admission clinics and given the pro-thrombotic tranexamic acid to avert bleeding during a total knee replacement procedure.

The coroner said the patient should have had a vascular consult prior to the operation and his treating team could have balanced the risk of intra-operative bleeding against a high risk of acute thrombosis of the mesenteric stents.

The inquest noted the hospital had since introduced a new pre-admission process with more robust safeguards to ensure at-risk patients had a vascular review prior to surgery.

More specialists are using My Health Record

Use of My Health Record (MHR) by specialists has increased since it became accessible through clinical software in late 2021, according to the Australian Digital Health Agency.

Its latest figures for February 2022 show that 20% of specialists have registered for the MHR and 9% have used it. In comparison 95% of public hospitals and 98% of GPs have used the MHR. While the specialist usage levels are still low they increased by 17% in January 2022, the Agency says, and the number of documents uploaded by specialists and viewed by other healthcare providers increased by 23%.

Public hospital viewing of MHR had doubled in the last year, it noted.

The Agency said the increase likely reflects the increasing proportion of clinical software products that are compatible with the MHR and have the discharge summaries and reports for diagnostic imaging and pathology.

Ongoing funding for the Agency was confirmed in the 2022 Budget, which noted total expenditure of almost $380 million for 2021–2022. The Agency was given a target of increasing provider use of the MHR by 15% a year and a 20% increase in e-prescribing.

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