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.
The necessity of bridging of anticoagulation for patients with AF using LMWH has been a controversial area. The BRIDGE trial, a randomised, controlled trial which involved almost 2000 patients was published in the New England Journal (22/06/15). The authors concluded that “In patients with atrial fibrillation who had warfarin treatment interrupted for an elective operation or other elective invasive procedure, forgoing bridging anticoagulation was noninferior to perioperative bridging with low-molecular-weight heparin for the prevention of arterial thromboembolism and decreased the risk of major bleeding.”
World Thrombosis Day may seem some way off but it is never too early to make a plan. There are lots of great ideas for promoting VTE awareness on the new website http://www.worldthrombosisday.org/. CLOT are pleased to support this important global event.
Members of the CLOT Committee and two CLOT members awarded a travel scholarship visited the ISTH conference in Toronto between 21st and 25th June. This year's conference included a busy two-day nurses and allied health professionals sessions where a vast number of topics from anticoagulation to haemophilia were covered by delegates from all over the world.
CLOT were pleased to award Sarah Bond, Anticoagulation pharmacist/anticoagulant service lead from Swindon and VTE nurse manager Kay Sumner from Lincoln with travel scholarships to attend the meeting. Both showed that they had been forward-thinking and innovative in their practice and would benefit from the opportunity to learn from and network with with international colleagues. Both will share their experience at this year's CLOT meeting.
Jo Boyd (pictured below), a CLOT member, presented a very interesting talk on the development of a community-based nurse-led Ultrasound scanning service for DVT which showed how sharing practice, education and crossing boundaries can vastly improve services.
Sue Rhodes, also a longstanding CLOT member, presented a talk on Shared decision making in Anticoagulant Management and also presented a poster, along with Sarah Bond, on their audit of the use of the DOAC drugs in their clinics in Swindon.
Huw Rowswell, the CLOT Secretary, presented a poster about his work on the comparison of risk factors and outcomes in community vs hospital acquired thrombosis.
Well done to all of them for having shared their work with a worldwide audience; it is very inspiring to see how UK practice often seems to lead the way.