News in brief: DOACs could replace warfarin in heart pumps; Therapeutic plasma exchange for refractory VITT; Polatuzumab as salvage and bridging treatment in r/r LBCL;

Thursday, 8 Jul 2021

DOACs could replace warfarin in heart pumps

DOACs could potentially replace warfarin as the anticoagulants used in a left ventricular assist device for heart failure, an Australian study suggests.

In vitro tests conducted by researchers at the Heart and Lung Transplant Unit, St. Vincent’s Hospital, Sydney, showed that apixaban was at least as effective as warfarin in preventing thrombus formation when used under simulated conditions in a continuous flow HeartWare left ventricular assist device.

The DOAC had a similar haemostatic profile to warfarin, and high-dose apixaban was not associated with pump clot, the study showed. Thrombosis findings were also similar to the aggregation assays that were performed. There also appeared to be reduced haemolysis with stable pump function in the apixaban and warfarin groups when compared with the control, aspirin, and dabigatran groups.

The investigators said the safe use of DOACs would represent a step forward for left ventricular assist device patients. but further evaluation was needed before changes to clinical recommendations can be made.

Therapeutic plasma exchange suggested for refractory VITT

Therapeutic plasma exchange to remove IgG is a promising treatment option for patients with vaccine-induced immune thrombotic thrombocytopenia (VITT)  that does not respond to initial treatment, Canadian clinicians suggest.

Writing in NEJM they report a case series of three patients with VITT after ChAdOx1 nCoV-19 (AstraZeneca) vaccination who had not responded to initial treatment of nonheparin anticoagulation and high-dose intravenous immune globulin (IVIG).

The patients showed normalisation of platelets and subsequently recovered despite their severe presentation.

The report authors said antibody removal or neutralization was plausibly effective in VITT because VITT is IgG-mediated, although further study is needed, since therapeutic plasma exchange with the use of plasma as replacement fluid would not elevate IgG to inhibitory levels.

We suggest consideration of therapeutic plasma exchange for thrombocytopenia and thrombosis that does not begin to abate after 5 days, continuing until platelet normalization. Earlier intervention could be considered,” they wrote.

Polatuzumab is a valuable salvage and bridging treatment in r/r LBCL

The antibody-drug conjugate polatuzumab vedotin (pola) may serve as effective salvage and bridging treatment for patients with refractory or relapsed (r/r) large B-cell lymphoma (LBCL), a study from Germany suggests.

The efficacy of pola in combination with bendamustine and rituximab (pola-BR) was investigated in a real-world setting in 105 patients with LBCL who had received a median of 3 prior treatment lines.

In 54 patients who received pola-BR as salvage treatment, the overall response rate was 48.1%, the 6-month progression-free survival was 27.7% and overall survival (OS) was 49.6%.

In a further 51 patients, about half could be successfully bridged with pola to the intended CAR T-cell therapy or intended allogeneic hematopoietic cell transplantation.

The combination of pola bridging and successful CAR T-cell therapy resulted in a 6-month OS of 77.9%.

The study, published in Blood Advances,  also showed that pola may be an option for patients with previous failure of CAR T-cell therapy, with seven of 12 patients responding to a pola-containing regimen.

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