News in brief: ISTH advice on anticoagulant-associated bleeding risk in VTE management; Healthcare staff bullied and stressed over PPE provision; Good practice guidance on anaemia investigations

Tuesday, 14 Jun 2022

ISTH advice on anticoagulant-associated bleeding risk in VTE management

The International Society on Thrombosis and Haemostasis (ISTH) has developed four recommendations on how to assess bleeding risk in VTE patients using anticoagulant therapy

Based on 34 studies evaluating predictors or risk prediction models for bleeding risk, the guidelines recommend routine estimation of a patient’s bleeding risk at diagnosis of acute VTE before anticoagulation therapy is initiated.

They also recommend bleeding risk assessment after completion of the treatment phase, and during the extended-phase anticoagulant therapy for VTE, at least annually; and more frequent evaluation in patients at high risk of bleeding.

Bleeding risk assessment should include  identification of the indication of concomitant use of platelet inhibitors or NSAIDs and avoiding concomitant use if possible. Other potentially modifiable predictors such as hypertension should also be identified early and targeted, they advise.

Routine standardised bleeding risk assessment is recommended during extended-phase anticoagulation.

“Preferably, this should include measurement of individual predictors combined with the use of a  validated prediction model such as the VTE-BLEED, the RIETE score and the ACCP risk table, the ISTH advice suggests.

More information: Journal of Thrombosis and Haemostasis.

Healthcare staff bullied and stressed over PPE provision

One in five frontline healthcare workers received no training on the use of personal protective equipment (PPE) for COVID-19 when the pandemic was at its height in 2021, and only half received formal training in the workplace, according to a survey of Victorian healthcare staff.

Responses from 2258 healthcare workers (80% women, 49% doctors and 40% nurses) revealed a wide range of problems with PPE provision in 2021, including a lack of PPE training (20%), lack of fit testing, insufficient PPE (25%) and reuse or extended use of PPE (47%).

More than three quarters (77%) of staff reported workplace bullying by management for being ‘troublemakers’ when they raised issues over PPE, and y more than one fifth (22%) reported moderate to severe anxiety related to the lack of training and provision of PPE.

Similarly, about half of staff (48%) reported confusion and concern  about inconsistent and frequently changing PPE guidelines that failed to recognise the airborne transmission of SARS-CoV-2.

“The lack of bargaining power for many respondents limited their agency to resolve matters further exacerbating physical, psychological and financial impacts,” said the authors of the study published in PLOS One.

Good practice guidance on anaemia investigations

Haematologists should consider and investigate globin gene abnormalities before employing next generation sequencing (NGS) to diagnose rare, inherited anaemias, a new Good Practice Paper has emphasised.

Also, NGS should only be used when acquired causes of anaemia are thought to be very unlikely, and following appropriate patient consent, experts stressed.

With regard to its positioning in the diagnostic pathway, NGS should generally only be used once the phenotype has been characterised.

“In particular, it should be established whether the patient has haemolysis, ineffective erythropoiesis, dyserythropoiesis or bone marrow failure, as this may direct the analysis of the variants identified (IC)”, according to the paper, published in the British Journal of Haematology.

Other recommendations outlined in the paper address important considerations when choosing the most appropriate NGS method, the criteria for reporting NGS variants, how variants should be stored and shared between labs, and the essential criteria for offering clinical-grade NGS.

The Good Practice Paper was jointly produced by the British Society for Haematology (BSH) and the European Haematology Association (EHA), with the guideline group including UK-based medical experts representing the BSH and members of the EHA Red Cell and Iron Scientific Working Group (SWG).

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