News in Brief: Palliative care service accused of ‘abhorrent’ discrimination; Deprescribe aspirin in DOAC users; Convalescent plasma falls out of favour despite $1 billion funding

Tuesday, 20 Apr 2021

Oncologist accuses palliative care service of ‘abhorrent’ discrimination

Cancer patients who choose to die at home under Victoria’s voluntary assisted dying laws are being shunned by Catholic Church-aligned palliative care services, an oncologist says.

Dr Cameron McLaren said it was ‘abhorrent’ that healthcare staff working for Eastern Palliative Care were not permitted to attend the homes of patients to verify the cause of death if the patient had died under the laws introduced in the state two years ago. Dr McLaren told The Age the refusal was discriminatory and unethical, causing shame and stigma for the families of the patients. There were also reports of pharmacists being denied entry to palliative care clinics if they were believed to have medications used for assisted dying, he said.

Deprescribe aspirin in DOAC users

Many patients using DOAC therapy for atrial fibrillation or VTE prevention are taking aspirin at the same time, putting them at increased bleeding risk without a significant reduction in thrombotic outcomes, new research.

A US registry based cohort study of 3280 patients taking DOACs found that one third (33.8%) were taking aspirin despite having no clear indication such as recent MI or valve replacement. After follow up of almost two years there was no difference in thrombosis rates between these patients and a propensity matched control group. However the patients taking DOAC and aspirin experienced more bleeding events compared with DOAC monotherapy (26.0 vs 31.6 bleeds per 100 patient years, P = .01).

“Efforts should be made to help clinicians identify and deprescribe [aspirin] for patients taking a DOAC without an indication for aspirin,” the investigators said in JAMA Internal Medicine.

Convalescent plasma falls out of favour despite $1 billion funding

Convalescent plasma is being abandoned as a potential treatment for COVID-19 because no good evidence has emerged to support it, according to US experts. The Infectious Diseases Society of America has now updated its guidance to recommend against the use of convalescent plasma in patients hospitalised with COVID-19, noting that existing data suggests that if a benefit exists, it is only useful when given early and with a high titre of neutralising antibodies.

In interviews with the New York Times, US Federal health officials said that despite $1 billion in government funding for trials it was difficult to justify further use of convalescent plasma because the evidence of benefit was limited and there was a risk of diverting resources away from more appropriate services.

Australian Red Cross Lifeblood announced on 9 April that it was no longer collecting convalescent plasma donations in Australia, based on the increasing international evidence of no benefit of the treatment for people in hospital with COVID-19.

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