NVAF patients on DOACs at lower stroke/SE risk versus warfarin
Non-valvular atrial fibrillation (NAVF) patients with high risk of gastrointestinal (GI) bleed appear less likely to suffer stroke or systemic embolism (SE) while on non-vitamin K antagonist oral anticoagulants (DOACs) than warfarin, a study suggests.
Published in JAMA Network Open, the study compared stroke and/or SE and major bleeding risk in 381,054 patients who were newly prescribed apixaban, dabigatran, rivaroxaban or warfarin between 2013 and 2015.
It found that apixaban (HR, 0.60; 95% CI, 0.52–0.68), dabigatran (HR, 0.75; 95% CI, 0.64–0.88) and rivaroxaban (HR, 0.79; 95% CI, 0.73-0.86) were associated with lower risk of stroke and/or SE compared with warfarin.
Apixaban (HR, 0.59; 95% CI, 0.56–0.63) and dabigatran (HR, 0.78; 95% CI, 0.70–0.86) were also associated with a lower risk of major bleeding, while rivaroxaban was associated with a higher risk versus warfarin, the authors wrote.
“This is one of the first real-world studies to compare [DOACs] in the patients with NVAF and high risk of GI bleed; the results may help inform decision-making regarding OACs in this high-risk patient population,” they concluded.
Systemic cancer therapy not affected by pandemic
Despite disruptions to cancer services during the first year of the COVID-19 pandemic, systemic cancer treatment was not substantially affected, Australian research shows.
A population-based study of cancer medicines dispensing, initiations and discontinuations found only small and temporary changes during COVID-19 compared to pre-pandemic levels.
The PBS data showed no significant changes in chemotherapy dispensing but an increase in immunotherapy and targeted therapy dispensing in March 2020 and July 2020.
“There were no notable differences in dispensings of different classes of antineoplastic medicines between the State of Victoria, which was subject to the most restrictive lockdown measures, and the rest of Australia,” the study authors said.
Overall, there was a small increase in antineoplastic medicine initiation in Australia – led by an increase in immunotherapy initiations which was not offset by a decrease in chemotherapy initiations.
A temporary increase in discontinuations of antineoplastic medicines was also seen in April 2020.
There was a sustained increase in the dispensing of granulocyte-colony stimulating factors from March 2020 while other supportive therapies such as ondansetron decreased and other antiemetics were unchanged.
Writing in The Lancet Regional Health-Western Pacific, the study authors said the minimal changes to systemic therapy likely reflected the relatively low number of COVID-19 cases in Australia. The same pattern was seen in New Zealand.
Doctor wins $450k damages for malicious reviews
A Sydney surgeon has been awarded $450,000 in defamation damages from a woman who mounted a campaign of online abuse and false claims against him after he refused to operate on her.
Dr Warwick Nettle, a Bondi-based plastic and reconstructive surgeon, became the target of virulent abuse, falsehoods and negative reviews from Catherine Cruse in 2018 when he declined to perform surgery on her, based on warnings from another surgeon who had previously treated her.
Dr Nettle took his case to the Federal Court of Australia, which found that his behaviour was professionally appropriate and justifiable, and that the online comments and maliciously false reviews reviews had seriously damaged both his professional reputation and his thriving practice.
As a results of Ms Cruse posting negative reviews, Dr Nettle’s “Google rating” fell from 5 to 3.5 stars and his workload declined significantly.
The court awarded damages of $450,000 to Dr Nettle and granted permanent injunctions barring Ms Cruse from posting further false and defamatory material about him. However Ms Cruse did not take part in the proceedings and could not be traced, having apparently deliberately concealed her whereabouts, the court was told.