News in brief: Therapeutic anticoagulation no benefit in COVID-19; Combination ibrutinib and venetoclax provides lasting remission in CLL; No sleep for patients in noisy, busy wards

Therapeutic anticoagulation offers no additional benefit in COVID-19 patients

Therapeutic anticoagulation with DOACs does not improves outcomes in patients hospitalised with COVID-19, a study has found.

In an open-label study, 615 patients hospitalised with COVID-19 and elevated D-dimer concentration were allocated to  therapeutic anticoagulation with rivaroxaban or enoxaparin followed by rivaroxaban to day 30, or prophylactic anticoagulation with enoxaparin or unfractionated heparin.

For the primary outcome of time to death, duration of hospitalisation, or duration of supplemental oxygen to day 30, there was no difference between the two groups  (34·8% vs 41·3% success outcomes respectively).

Safety outcomes were almost four times worse in the DOAC group, major or clinically relevant non-major bleeding occurring in 8% of patients assigned therapeutic anticoagulation and 2% assigned prophylactic anticoagulation (relative risk 3·64)

“Therefore, use of therapeutic-dose rivaroxaban, and other direct oral anticoagulants, should be avoided in these patients in the absence of an evidence-based indication for oral anticoagulation,” the study authors concluded in The Lancet.

Ibrutinib and venetoclax beneficial for previously untreated patients with CLL.

A combination of ibrutinib and venetoclax provides lasting disease remission in patients with newly diagnosed chronic lymphocytic leukaemia (CLL), according to US research.

In a phase 2 study, 80 previously untreated patients with CLL had a three-year progression-free survival (PFS) of 93% and a three-year overall survival of 96% after treatment with the combination.

The patients had a median age of 65 years, 30% of whom were over age 70. Overall, 92% had high-risk genetic anomalies, and response rates were the same for the high-risk subgroup of patients.

According to the findings published in JAMA Oncology, the bone marrow undetectable measurable residual disease (U-MRD) responses improved with ongoing combined ibrutinib plus venetoclax. After 12 cycles of combination therapy, 56% of patients achieved bone marrow U-MRD, and after 24 cycles of combination therapy, 66% of patients achieved bone marrow U-MRD remission. A total of 75% of patients achieved bone marrow U-MRD remission at any time during the study.

The treatment was well-tolerated and the toxicity profile of both drugs was consistent with other studies, with no additional toxicity observed with the combination, according to researchers at The University of Texas MD Anderson Cancer Center.

Quiet please: noise the main reason for sleep disruption in hospitals

Almost half of hospital inpatients have their sleep disrupted, with noise being the main culprit, Australian research shows.

A study involving 60 patients at Melbourne’s Box Hill hospital found that sleep was disturbed in 45% of patients, with the problem common to those in shared rooms and those in single rooms distance from the nursing station.

Lighting levels were appropriately low across all the ward locations studied, whereas sound levels were higher in the shared and single rooms group compared to a ‘control’ setting of a sleep laboratory. Noise was also rated as the greatest environmental disturbance by 70% of ward patients compared to 10% in the sleep laboratory.

Operational interruptions were also a major factor in disrupted sleep, with patients experiencing an average of around six per night, according to the findings published in Sleep and Breathing.

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