The link between VTE and cancer is well known. However, the need for extensive screening f or occult cancer in patients who have an unprovoked VTE remains unclear. The SOME trial, published in the New England Journal (22/06/15), compared standard screening ( complete history taking and physical examination, measurement of complete blood counts and serum electrolyte and creatinine levels, liver-function testing, and chest radiography and sex-specific examinations) with enhanced screening which included a CT scan. The rates of occult cancer detection in the study proved to be surprisingly low, and the benefits of the additional CT scan were limited. The authors concluded that: “ In our trial, a screening strategy for occult cancer that included comprehensive CT of the abdomen and pelvis did not lead to fewer missed cancers than the number missed with a limited screening strategy. Furthermore, the screening strategy that included CT did not appear to detect significantly more occult cancers (including early cancers), shorten the time to cancer diagnosis, or reduce cancer-related mortality.”
The New England Journal of Medicine (22/06/15) has published the results of the Reversal Effects of Idarucizumab on Active Dabigatran (REVERSE-AD) trial. The results indicate that a complete reversal of the anticoagulant effects of Dabigatran in 88-98% of the 90 patients studied was achieved. The trial included patients who had life-threatening bleeding whilst on Dabigatran or who required urgent surgery. It therefore brings the prospect of a fully-reversible DOAC a step closer.