Coagulation

News in brief: DOACS superior to warfarin in valvular AF; Chronic irAEs common with anti–PD-1 therapy; Treat fatigue to improve cognition in blood cancer patients;

Wednesday, 31 Mar 2021


DOACS vs warfarin for valvular AF

Direct oral anticoagulants (DOACs) appear to be more effective and safer than warfarin for people with valvular atrial fibrillation (AF), a US study has found.

A retrospective cohort study involving 56,336 patients with valvular AF matched on propensity score found that after median follow-up of 134 days the use of DOACs was associated with lower risk for ischaemic stroke or systemic embolism (hazard ratio [HR], 0.64 [95% CI, 0.59 to 0.70]) compared to new users of warfarin. Similarly, DOAC users had a lower risk of major bleeding events (HR, 0.67 [CI, 0.63 to 0.72]) compared to warfarin users

The results for safety and effectiveness were consistent for apixaban and rivaroxaban, but for dabigatran the results were consistent only for the major bleeding outcome (HR, 0.81 [CI, 0.68 to 0.97]) but not for effectiveness (HR, 1.03 [CI, 0.81 to 1.31]).

The findings are published in Annals of Internal Medicine.


Chronic irAEs common with anti–PD-1 therapy

Chronic immune-related adverse events with anti–PD-1 therapy are more common than previously recognised and may persist unresolved, new research shows.

While most irAEs with anti–PD-1 therapy occur in visceral organs in the first 12 weeks of treatment, almost half of patients may also develop chronic low-level irAEs in non-visceral organs, according to a study that included several Australian centres.

A multicentre cohort study of 387 patients with stage III to IV melanomas treated with adjuvant pembrolizumab or nivolumab found that 43% of patients developed a chronic irAE, beyond 12 weeks of treatment. And although most (96.4%) were mild, a high proportion (85.6%) persisted until last available follow-up.

Chronic irAEs most commonly affected nonvisceral systems such as endocrine (hypothyroidism, adrenal insufficiency), joints (arthritis), salivary glands (xerostomia), eye, and peripheral nerves (neurotoxicities).

The authors said the findings had clinical significance given the widening indications for use of  antiPD-1 therapy and the  increasing number of long-term cancer survivors treated with these agents.

“The adjuvant patient population presents unique considerations; they may have been cured by surgery alone and have longer or normal life expectancies. Thus persistent, life-altering, or life-threatening irAEs should be characterised in detail and integrated into patient counselling and treatment decision-making,” they wrote in JAMA Oncology.


Treat fatigue to improve cognition in blood cancers 

Tackling fatigue may improve the cognitive challenges that patients with haematological cancers face following stem cell transplant, a small study shows. 

The researchers from South Australia found haematological cancer patients who had received an allogeneic stem cell transplant within the previous 5 years reported significantly poorer cognitive ability and greater cognitive impairment than healthy age-matched controls. 

Fatigue was also significantly associated with perceived cognitive ability and impairment in the patient group.

While the relationship between fatigue and cognitive functioning may be bi-directional, treating fatigue as a means to improve cognitive performance is worth consideration, the study authors wrote in their paper published in the European Journal of Cancer Care.

“An improvement in fatigue may also result in an improvement in CRCI and mood, which may impact overall health and even survival,” the authors suggested. 

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