Anticoagulation Therapy For Prevention Research Articles

Comparison of thrombodynamic methods and routine hemostasis tests in the evaluation of hypercoagulable syndrome in chronic glomerulonephritis

Nephrotic syndrome (NS) is associated with a high risk of thrombotic complications. In this group of patients, routine local tests for assessing hemostasis do not accurately reflect hypercoagulable state. Global functional tests for assessing hemostasis, including thrombodynamics (TD), are considered promising for assessing disorders in the blood coagulation system of these patients. To compare the rate of hypercoagulability according to routine hemostatic tests and TD and to evaluate the factors associated with increased risk of thrombotic complications in patients with chronic glomerulonephritis (CGN). The study included 94 patients with active CGN who were not receiving anticoagulant therapy; 63 (80.3%) patients had NS, and 31 (19.7%) had active CGN without NS. Hemostasis parameters were assessed using local coagulation tests and TD test. Using logistic regression analysis, factors associated with the risk of thrombosis were assessed. Of the 94 patients with active CGN in 63 without preventive anticoagulant therapy, hypercoagulability according to routine tests was detected in 6 (9.5%) patients with NS and in 3 (9.7%) patients without NS (p<0.05). Hypercoagulability according to the TD test was detected in 24 (53.9%) patients with NS and in 5 (32.2%) without NS (p<0.05). The formation of spontaneous clots was observed in 29 (30.9%) of patients with CGN, most of them 24 (83%) with NS. 10.6% of patients in our cohort experienced thromboembolic events. The risk of thromboembolic events according to the univariate regression analysis was associated with older age, higher lipid levels, use of glucocorticosteroids and detection of spontaneous clots by the TD test. No association of thromboembolic events with abnormalities in routine hemostasis tests was obtained. In patients with CGN with nephrotic syndrome, hypercoagulability is detected in 9.5% of cases with routine coagulation tests and in 53.9% of cases with TD test. Detection of spontaneous clots by TD test is associated with a risk of thromboembolic events.

Pulmonary artery thrombosis prophylaxis and treatment in clinical practice and experiment

The effectiveness of anticoagulant therapy in the prevention and treatment of pulmonary artery thrombosis and the possibility of anti-inflammatory therapy in preventing this complication in clinical practice and experiments were assessed. Data from patients with a new coronavirus infection and those suffering from urgent noninfectious pathology with confirmed pulmonary artery thrombosis were retrospectively analyzed. The outcomes of anticoagulant therapy and anticoagulant therapy combined with glucocorticoid and/or anticytokine drugs were assessed. Histological preparations of the lung vessels of patients were examined. Using an experimental model of rats with induced thrombosis of the posterior vena cava, changes in the pulmonary artery branches were assessed in the main group administered with edible mussel (Mytilus edulis) hydrolyzate and the control group given a physiological solution. No statistically significant relationship was found between the therapeutic, intermediate, and preventive anticoagulant therapy regimens and mortality, changes in lung dynamics, and D-dimer levels in 313 patients with new coronavirus infection. No predominance of any anticoagulant therapy regimen used was found among deceased patients. Thirty-nine patients were treated with glucocorticoid and/or anticytokine drugs in the presence of anticoagulant therapy. No statistically significant relationship in the onset of thrombotic complications was found between the groups receiving therapy with glucocorticoid and anticytokine drugs. No differences were noted in the drug-induced pathomorphosis of the wall of the pulmonary artery branches in the group receiving anticoagulant therapy or in the group receiving a combination of anticoagulant therapy and glucocorticoid and/or anticytokine drugs. Pulmonary artery thrombosis developed in all 19 patients suffering from urgent noninfectious pathology, 11 of whom were under anticoagulant therapy. In 12 of 15 rats in the control group with thrombosis of the posterior vena cava, blood clots were found in the lumen of the pulmonary artery branches. In 14 rats of the main group administered M. edulis hydrolyzate, no blood clots were found in the pulmonary artery branches. Thus, the systemic effects of anticoagulant therapy were offset by the local prothrombotic effects of the vascular wall caused by inflammation. Glucocorticoid and anticytokine drugs did not affect inflammatory changes in the vascular wall and did not prevent pulmonary artery thrombosis. The introduction of M. edulis in the experiment prevented pulmonary artery thrombosis in the presence of posterior vena cava thrombosis, which indicates a promising direction in the search for pathogenetic prevention of this complication.

Mid-term analysis of prospective cohort study of rivaroxaban in preventing CRT in breast cancer

Objective: To explore the efficacy and safety of Rivaroxaban in preventing catheter related thrombosis (CRT) in patients with breast cancer who are undergoing central venous catheter chemotherapy, and provide basis for making standardized prevention and treatment strategies. Methods: In this research, a prospective cohort study was adopted, and breast cancer patients who received central venous catheter chemotherapy in Sanhuan Cancer Hospital during September 2020 to March 2022 were selected as a treatment group to take the rivaroxaban anticoagulation therapy with 10 mg.po.qd for one month. The control group got no preventive anticoagulation therapy. Vascular ultrasound examination was taken to confirm the occurrence of CRT, and a chi-square test was done for comparison the disparity between the groups. Logistic regression was applied to analyze the univariate and multivariate factors for the formation of CRT. Results: In the research, a total of 235 patients were selected, and there were a total of 19 035 days of catheterization with 81 days of catheterization on average. While in the control group, the incidence of CRT was 28.0% (33/118), the incidence of CRT in the treatment group was 20.5% (24/117), the difference was no significant (P=0.183). Subgroup analysis results showed that the peripherally inserted central catheter (PICC) was performed in 165 cases with the CRT incidence of 18.2% (30/165) and thrombosis was mostly seen around axillary vein, accounting for 63.3%. Subclavian vein catheterization was performed in 63 cases with the CRT incidence of 39.7% (25/63), and thrombosis was mostly seen around subclavian vein, accounting for 88.0% (22/25). Implantable venous access port was implanted in 7 cases around subclavian vein and internal jugular vein with the CRT incidence of 28.6% (2/7). The patients who developed CRT within 30 days after catheterization accounted for 54.4% (31/57), 22.8% (13/57) in a period during 30 days and 60 days) and 22.8% (13/57) in a period during 60 days and 180 days). The diagnosed CRT patients had been treated with rivaroxaban 15 mg.bid.po for 3 months. During the 3 months, 100.0% of the thrombosis waned, 71.9% (41/57) of the thrombosis waned within 30 days, 19.3% (11/57) in a period during 30 and 60days and 8.8% (5/57) in a period during 60 days and 90 days. Univariate and multivariate analysis indicated that the risk of CRT in subclavian vein catheterization was higher than that in PICC, respectively (OR=2.898, 95% CI:1.386-6.056 P=0.005), and the type of catheterization was an independent factor for the formation of thrombosis. Safety analysis result showed that in the prevention of CRT, rivaroxaban treatment did not induce drug-related bleeding, liver function damage, bone marrow suppression or any other side effects. While CRT diagnosed patients were treated with anticoagulation, they kept the central venous catheter, and the infusion was smooth. These patients all finished the anti-tumor treatment as planned, and no abnormalities like new thrombosis or pulmonary embolism were observed. Conclusions: In the mid-term analysis, the proportion of Rivaroxaban in preventing anticoagulant CRT decreases, but it don't reach statistical significance. The sample size should be further increased for observation. Rivaroxaban is proved effective and very safe in the treatment of CRT, and does not affect the concurrent chemotherapy. Medical personnel should carry out the policy of "early prevention, early detection and early treatment" for CRT so as to improve the patients' quality of life.

Apixaban to Prevent Recurrence After Cryptogenic Stroke in Patients With Atrial Cardiopathy

Atrial cardiopathy is associated with stroke in the absence of clinically apparent atrial fibrillation. It is unknown whether anticoagulation, which has proven benefit in atrial fibrillation, prevents stroke in patients with atrial cardiopathy and no atrial fibrillation. To compare anticoagulation vs antiplatelet therapy for secondary stroke prevention in patients with cryptogenic stroke and evidence of atrial cardiopathy. Multicenter, double-blind, phase 3 randomized clinical trial of 1015 participants with cryptogenic stroke and evidence of atrial cardiopathy, defined as P-wave terminal force greater than 5000 μV × ms in electrocardiogram lead V1, serum N-terminal pro-B-type natriuretic peptide level greater than 250 pg/mL, or left atrial diameter index of 3 cm/m2 or greater on echocardiogram. Participants had no evidence of atrial fibrillation at the time of randomization. Enrollment and follow-up occurred from February 1, 2018, through February 28, 2023, at 185 sites in the National Institutes of Health StrokeNet and the Canadian Stroke Consortium. Apixaban, 5 mg or 2.5 mg, twice daily (n = 507) vs aspirin, 81 mg, once daily (n = 508). The primary efficacy outcome in a time-to-event analysis was recurrent stroke. All participants, including those diagnosed with atrial fibrillation after randomization, were analyzed according to the groups to which they were randomized. The primary safety outcomes were symptomatic intracranial hemorrhage and other major hemorrhage. With 1015 of the target 1100 participants enrolled and mean follow-up of 1.8 years, the trial was stopped for futility after a planned interim analysis. The mean (SD) age of participants was 68.0 (11.0) years, 54.3% were female, and 87.5% completed the full duration of follow-up. Recurrent stroke occurred in 40 patients in the apixaban group (annualized rate, 4.4%) and 40 patients in the aspirin group (annualized rate, 4.4%) (hazard ratio, 1.00 [95% CI, 0.64-1.55]). Symptomatic intracranial hemorrhage occurred in 0 patients taking apixaban and 7 patients taking aspirin (annualized rate, 1.1%). Other major hemorrhages occurred in 5 patients taking apixaban (annualized rate, 0.7%) and 5 patients taking aspirin (annualized rate, 0.8%) (hazard ratio, 1.02 [95% CI, 0.29-3.52]). In patients with cryptogenic stroke and evidence of atrial cardiopathy without atrial fibrillation, apixaban did not significantly reduce recurrent stroke risk compared with aspirin. ClinicalTrials.gov Identifier: NCT03192215.

Selection of Non-vitamin K Antagonist Oral Anticoagulant for Stroke Prevention in Atrial Fibrillation Based on Patient Profile: Perspectives from Vietnamese Experts. Part 1.

In Asia, especially Vietnam, AF is a common arrhythmia and is linked to a higher risk of stroke and systemic embolism. Anticoagulation therapy for stroke prevention in AF patients can result in bleeding complications. To effectively manage AF, adopting appropriate anticoagulation and addressing modifiable risk factors are crucial. Vietnamese clinicians are particularly interested in non-vitamin K antagonist oral anticoagulants (NOACs), a recent development in AF treatment. However, the lack of head-to-head trials comparing NOACs makes selecting a specific NOAC challenging. This review aims to provide a comprehensive overview of the available clinical evidence on NOACs for stroke prevention in AF to assist clinicians in making informed decisions and improving treatment outcomes in patients with AF. The first part of this review will present the current landscape of AF in Vietnam, focusing on AF prevalence and highlighting gaps in clinical practice. Furthermore, this part extensively discusses the anticoagulation strategy for both primary and secondary stroke prevention in AF.

10-year trends in oral anticoagulation therapies and ischemic stroke among 157,583 patients with non-valvular atrial fibrillation

Abstract Purpose Initiation of oral anticoagulation therapy (OAC) for stroke prevention in patients with atrial fibrillation (AF) is often suboptimal in clinical practice. We aimed to describe trends in OAC uptake and incidence of ischemic stroke over the past decade. Methods We retrospectively analyzed consecutive patients with non-valvular (NV) AF between January 2012 and July 2022 from 16 public hospitals. Annual incidence of AF was the number of new AF cases as proportion of adult population reported by Census and Statistics Department. Prescription of OAC (vitamin K antagonist (VKA) and direct oral anticoagulants (DOAC)) were recorded. OAC uptake was defined as initiation of OAC within 12 months from AF diagnosis. Incidence of ischemic stroke was calculated for both incident and prevalent AF cohorts over time. Logistic regression was conducted to identify predictors of OAC uptake. Results 157,583 NVAF patients (mean age 76.6±12.5 and female 49.6%) with mean CHA2DS2VASC 2.6±1.3 were identified. Between 2012 and 2022, incidence of new AF was steady across the years with mean of 0.19%±0.03% (range 0.16% to 0.24%) per year. OAC prescription increased from 15.3% to 46.0% and the incidence of ischemic stroke decreased significantly from 4.0% to 0.6% over the last decade (both p for trend &amp;lt;0.01). DOAC use increased steadily from 6.2% to 41.0% whereas VKA decreased from 9.1% to 3.5% (Figure). Mean time from AF diagnosis to OAC prescription was 0.6±1.6 months. Of all patients prescribed OAC, 40.8% initiated OAC within 1 month after AF diagnosis. CHA2DS2VASC scores ≥4 was associated with higher likelihood of OAC uptake (OR=1.74 (95%CI: 1.69-1.78). Conclusion Our real-world data demonstrated steady incidence of new NVAF diagnosis with increasing trend in OAC prescription, predominantly DOAC and decreasing incidence ischemic stroke over the last decade. However, overall utilization of OAC for stroke prevention remains suboptimal.

Abstract 17712: The Discrimination Ability of the CHA2DS2-VASc Score for Predicting Ischemic Stroke in Patients With and Without Atrial Fibrillation: An Updated Meta-Analysis

BACKGROUND: The CHA2DS2-VASc score guides anticoagulation therapy for stroke prevention in non-valvular atrial fibrillation (NVAF) patients. A previous meta-analysis showed a moderate discrimination ability of CHA2DS2-VASc score to detect stroke in patients with &amp; without NVAF. In the presence of newly published data over the past three years, there is a need to recalibrate the existing statistical evidence. METHODS: A comprehensive literature search was conducted across PubMed, Embase, CENTRAL (the Cochrane Library), &amp; Google Scholar from inception till May 2023. All studies evaluating the discrimination ability of the CHA2DS2-VASc score, as measured by the C statistic, for short (&lt;2 years), intermediate (2-5 years), &amp; long-term (&gt;5 years) follow-ups in patients with &amp; without NVAF were included. The generic inverse variance weighted random effects method was used to pool C-statistic &amp; corresponding standard errors (SEs) from each study. RESULTS: A total of 28 studies with a population of 639450 patients were included. Seventeen studies (n=500555) reported the discrimination ability of CHA2DS2-VASc score for NVAF patients, &amp; 11 studies (n=138895) for patients without NVAF. The summary C statistic for short-term follow up was 0.66 (0.62-0.70) for NVAF subgroup. For mid-term follow-up, the pooled C statistic was 0.65 (0.63-0.67), while being 0.63 (0.60-0.66) &amp; 0.68 (0.66-0.70) for the subgroup with NVAF &amp; without NVAF respectively. The CHA2DS2-VASC score showed moderate discrimination [0.66 (0.62-0.70)] at long-term follow up (NVAF [0.58 (0.55-0.61)]; without NVAF [0.67 (0.64-0.70]). CONCLUSION: CHA2DS2-VASc score has moderate &amp; similar discrimination ability for detecting stroke in both NVAF &amp; non-NVAF patients.

Clinical Outcomes of Left Atrial Appendage Occlusion Versus Switch of Direct Oral Antcoagulant in Atrial Fibrillation: A Territory-Wide Retrospective Analysis.

Background Left atrial appendage occlusion (LAAO) has emerged as an alternative to oral anticoagulation therapy for stroke prevention in atrial fibrillation, but data comparing LAAO with direct oral anticoagulant (DOAC) are sparse. Methods and Results This cohort study compared LAAO (with or without prior anticoagulation) with a switch of one DOAC to another DOAC by 1:2 propensity score matching. The primary outcome was a composite of all-cause mortality, ischemic stroke, and major bleeding. A total of 2350 patients (874 in the LAAO group and 1476 in the DOAC switch group) were included. After a mean follow-up of 1052±694 days, the primary outcome developed in 215 (24.6%) patients in the LAAO group and in 335 (22.7%) patients in the DOAC switch group (hazard ratio [HR], 0.94 [95% CI, 0.80-1.12]; P=0.516). The LAAO group had a lower all-cause mortality (HR, 0.49 [95% CI, 0.39-0.60]; P<0.001) and cardiovascular mortality (HR, 0.49 [95% CI, 0.32-0.73]; P<0.001) but similar risk of ischemic stroke (HR, 0.83 [95% CI, 0.63-1.10]; P=0.194). The major bleeding risk was similar overall (HR, 1.18 [95% CI, 0.94-1.48], P=0.150) but was lower in the LAAO group after 6 months (HR, 0.71 [95% CI, 0.51-0.97]; P=0.032). Conclusions LAAO conferred a similar risk of composite outcome of all-cause mortality, ischemic stroke, and major bleeding, as compared with DOAC switch. The risks of all-cause mortality and cardiovascular mortality were lower with LAAO.

Comparative evaluation of preventive anticoagulant therapy regimens in the wounded

Introduction. Currently, the issues of prescribing anticoagulant therapy to the wounded are poorly studied, the doses of drugs and the timing of its implementation have not been determined.Aim. To study various modes of anticoagulant therapy for the prevention of venous thrombosis of the lower extremities in the wounded after surgery using the parameters of the plasma hemostasis system and the Thrombodynamics test.Materials and methods. A prospective study was conducted, which included 90 wounded with mine-explosive/gunshot injury receiving anticoagulant therapy in preventive doses. The studies were carried out on the equipment of the Thrombodynamics recorder (HemaCor, Moscow). The patients were divided into 3 groups: 1 group, which included 30 patients taking rivaroxaban at a dose of 10 mg/day, 2 group of 30 patients receiving enoxaparin sodium at a dose of 40 mg once a day, 3 group consisting of 30 patients receiving enoxaparin sodium 40 mg 2 times a day. In the dynamics of treatment, the parameters of the plasma hemostasis system and the parameters of the Thrombodynamics test were evaluated.Results. It was revealed that during preventive anticoagulant therapy, there were no significant differences in the standard parameters of the coagulogram, when studying the parameters of the Thrombodynamics test, significant differences wereobserved between groups 1 and 3 in values (V/VSt, Vi, Tlag, СS), between group 2 and 3 in parameter (V/VSt, Vi, Tlag, СS), between group 1 and group 2 in the value of D. A statistically significant relationship was found between the Thrombodynamics parameter D and the indicators of TV, prothrombin by Quick, and fibrinogen content.Conclusion. The Thrombodynamics test can be used as a potential tool for a personalized approach to monitoring the hemostasis system in the wounded.

Impact of leaflet thrombosis on valve haemodynamic status after transcatheter aortic valve replacement

ObjectivesThe effect of subclinical leaflet thrombosis, characterised by hypoattenuated leaflet thickening (HALT), on the valve haemodynamic function and durability of the bioprosthetic valve, is not yet determined. We determined the...

Mitochondrially targeted tamoxifen in patients with metastatic solid tumours: an open-label, phase I/Ib single-centre trial.

Mitochondria present an emerging target for cancer treatment. We have investigated the effect of mitochondrially targeted tamoxifen (MitoTam), a first-in-class anti-cancer agent, in patients with solid metastatic tumours. MitoTam was tested in an open-label, single-centre (Department of Oncology, General Faculty Hospital, Charles University, Czech Republic), phase I/Ib trial in metastatic patients with various malignancies and terminated oncological therapies. In total, 75 patients were enrolled between May 23, 2018 and July 22, 2020. Phase I evaluated escalating doses of MitoTam in two therapeutic regimens using the 3+3 design to establish drug safety and maximum tolerated dose (MTD). In phase Ib, three dosing regimens were applied over 8 and 6 weeks to evaluate long-term toxicity of MitoTam as the primary objective and its anti-cancer effect as a secondary objective. This trial was registered with the European Medicines Agency under EudraCT 2017-004441-25. In total, 37 patients were enrolled into phase I and 38 into phase Ib. In phase I, the initial application of MitoTam via peripheral vein indicated high risk of thrombophlebitis, which was avoided by central vein administration. The highest dose with acceptable side effects was 5.0mg/kg. The prevailing adverse effects (AEs) in phase I were neutropenia (30%), anaemia (30%) and fever/hyperthermia (30%), and in phase Ib fever/hyperthermia (58%) together with anaemia (26%) and neutropenia (16%). Serious AEs were mostly related to thromboembolic (TE) complications that affected 5% and 13% of patients in phase I and Ib, respectively. The only statistically significant AE related to MitoTam treatment was anaemia in phase Ib (p=0.004). Of the tested regimens weekly dosing with 3.0mg/kg for 6 weeks afforded the best safety profile with almost all being grade 1 (G1) AEs. Altogether, five fatalities occurred during the study, two of them meeting criteria for Suspected Unexpected Serious Adverse Events Reporting (SUSAR) (G4 thrombocytopenia and G5 stroke). MitoTam showed benefit evaluated as clinical benefit rate (CBR) in 37% patients with the largest effect in renal cell carcinoma (RCC) where four out of six patients reached disease stabilisation (SD), one reached partial response (PR) so that in total, five out of six (83%) patients showed CBR. In this study, the MTD was established as 5.0mg/kg and the recommended dose of MitoTam as 3.0mg/kg given once per week via central vein with recommended preventive anti-coagulation therapy. The prevailing toxicity included haematological AEs, hyperthermia/fever and TE complications. One fatal stroke and non-fatal G4 thrombocytopenia were recorded. MitoTam showed high efficacy against RCC. Smart Brain Ltd. For the Czech translation of the abstract see Supplementary Materials section.

Research progress of nephrotic syndrome accompanied by thromboembolism.

Thromboembolism (TE) is a common and serious complication of nephrotic syndrome (NS). NS is associated with hypercoagulability, which may be induced by changes in coagulation, anticoagulant, and fibrinolytic factors. Moreover, accumulating evidence supports the hypothesis that the complex interactions between genetic and acquired risk factors in TE should be considered and that genetic susceptibility should not be ignored. Extracellular vesicles (EVs) also play unique roles. Further research on EVs may provide new insights into the discovery and treatment of TE associated with NS. The occurrence of NS accompanied by TE may be associated with various risk factors. Preventive anticoagulant therapy can not only reduce the risk of TE in patients but also aggravate the risk of bleeding. Heparin and vitamin K antagonists (VKAs), traditional anticoagulant drugs, have been extensively applied in the prevention and treatment of thromboembolic diseases, and emerging direct oral anticoagulants (DOACs) also provide an alternative choice. Owing to the particularity of NS, the safe application of DOACs still needs to be addressed. This review aimed to comprehensively describe the pathophysiology of TE in NS, as well as analyze the associated risk factors, the opportunity for preventive anticoagulation, and current anticoagulant information.

WITHDRAWN: Adherence to European guidelines for the use of aspirin in primary health care

The Publisher regrets that this article is an accidental duplication of an article that has already been published, 10.1016/j.repc.2022.03.007. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal

Adherence to European guidelines for the use of aspirin in primary health care

Introduction and objectivesCardiovascular disease remains a leading cause of global morbidity and mortality. The administration of low doses of aspirin in secondary prevention of atherosclerotic cardiovascular disease (ASCVD) has been clearly established. However, the most recent guidelines do not recommend aspirin in primary prevention, reserving it for high-risk patients and after a risk/benefit assessment. The aim of this study was to assess adherence to European guidelines for the use of aspirin in primary and secondary prevention of ASCVD in primary health care. MethodsThe study population consisted of individuals aged >50 years registered at two primary health care units without (primary prevention) and with previous ASCVD events (secondary prevention). ResultsWe studied a total of 1262 individuals, 720 in primary prevention and 542 in secondary prevention. A total of 61 individuals (8.5%) were under aspirin therapy in primary prevention, most of them taking 150 mg/day (57%). In secondary prevention, 195 patients (27%) were receiving aspirin only, most taking 150 mg/day (52%), and 166 patients (31%) were not under any antithrombotic or anticoagulant therapy. The 100 mg dosage was predominant in patients with ischemic heart disease with (64%) and without (64%) angina, as well as those with myocardial infarction (61.5%) and peripheral vascular disease (62%). ConclusionsIn this study, the prevalence of aspirin use in primary prevention was 8.5%. We found that 30% of patients were not taking either antithrombotic or anticoagulation therapy in secondary prevention. In both primary and secondary prevention, the 150 mg dosage was predominant.

Гіпереозинофілія як фактор ризику тромбоемболії легеневої артерії при онкологічних захворюваннях у практиці лікаря-інтерніста

Abstract. Pulmonary embolism is an urgent problem today. Diseases of the cardiovascular system, hereditary factors of impaired hemostasis, childbirth and pregnancy, surgical interventions, injuries, immobilization, dehydration, etc., can be risk factors for increased blood clot formation. In addition, one of the factors that significantly increases the risk of thrombosis is malignant neoplasms. It should be noted that there are factors that are rarely mentioned in the scientific literature as a risk factor for thrombosis, for example, blood hypereosinophilia. An increase in the level of eosinophils in peripheral blood can occur against the background of allergic and autoimmune diseases, parasitic and fungal infections, some diseases of the gastrointestinal tract, bone marrow diseases. The article reveals the pathogenetic basis of the influence of hypereosinophilia on the risk of thrombosis. Hypereosinophilia syndrome is closely associated with thrombosis, which may recur despite adequate anticoagulation or warfarin therapy. Eosinophils accumulate and express tissue factor and after its activation can initiate coagulation. The article describes the clinical case of a patient with lung cancer, which was accompanied by a leukemic reaction in the form of hypereosinophilia, and was complicated by deep vein thrombosis of the lower extremities and pulmonary embolism. The example of a clinical case shows the complex mechanism of hemostasis disorders against the background of the presence of a malignant neoplasm, especially when combined with paraneoplastic hypereosinophilia, which is an additional risk factor for the development of treatment-resistant venous thrombosis of various locations and thromboembolism of the pulmonary artery and requires preventive anticoagulation therapy, as well as more intensive and long-term anticoagulant therapy when deep vein thrombosis and pulmonary embolism has already developed.

Cost-Utility Analysis Comparing Direct Oral Anticoagulant and Low Molecular Weight Heparin Therapies for Secondary Prevention of Cancer-Associated Thrombosis

A Markov model for cancer patients eligible to receive rivaroxaban, edoxaban, apixaban, enoxaparin, or dalteparin was used to conduct a cost-utility analysis. Clinical scenarios were analyzed based on 6- and 60-month time horizons from the US healthcare system and societal perspectives. The main outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost in US dollars per quality-adjusted life year (QALY). One-way and probabilistic sensitivity analyses were performed to evaluate the robustness of the results. DOACs were cost-saving and clinically superior to LMWHs and were associated with a cost change ranging from -$9134.66 to -$15,281.92 and incremental effectiveness of 0.43-1.25 QALYs among four clinical scenarios. The most influential model inputs for ICER were the utility associated with LMWH use and probabilities of non-VTE and non-bleeding related death. Probabilistic sensitivity analyses were consistent with the results. DOACs were found to dominate LMWHs, suggesting that DOACs may be a cost-effective alternative to LMWHs for CAT. This study can help inform decision-makers on the cost-effectiveness of anticoagulation strategies and help in the development of future practice recommendations for cancer patients.

Left atrial appendage occlusion versus standard of care in patients with atrial fibrillation and a prior thrombo-embolic event despite oral anticoagulant therapy: a propensity score matched comparison

Abstract Introduction Patients with atrial fibrillation (AF) that suffer from ischemic stroke despite oral anticoagulant (OAC) therapy have a very high risk of recurrent stroke and better prevention strategies are needed. Left atrial appendage occlusion (LAAO) is a promising secondary prevention strategy that may provide mechanical protection in patients that suffer from thrombo-embolic events under OAC. However, evidence showing effectiveness of LAAO in this population is scarce and the current international guidelines only consider LAAO in patients with a contra-indication for OAC. Purpose To compare percutaneous LAAO to standard-of-care including continuing/switching anticoagulation therapy for secondary stroke prevention in patients with AF and a prior thrombo-embolic event and/or LAA thrombus under OAC therapy. Methods The STR-OAC LAAO cohort is an international collaboration combining a selection of patients from multiple LAAO registries (22 participating centers). Patients that underwent percutaneous LAAO because of a thrombo-embolic event and/or LAA thrombus on OAC were included. Propensity score matching (optimal matching method, 1:1 ratio) with a previously published multi-center dataset of patients continuing/switching anticoagulation treatment after a thrombo-embolic event was performed to adjust for imbalances in age, sex, hypertension, diabetes mellitus and CHA2DS2-VASc score. The primary outcome was ischemic stroke. Time-to-event analysis was performed with Kaplan-Meier curves and Cox-proportional-hazard regression analyses. Results A total of 404 patients underwent LAAO between 2010–2021 and were included in the STR-OAC LAAO cohort. Mean age was 72±9 years; 44% was female and mean CHA2DS2-VASc and HAS-BLED score were 4.8±1.7 and 2.5±1.4, respectively. Most patients received a Watchman or Amplatzer device (53% and 43%). Oral anticoagulation was discontinued after LAAO at discharge or after confirmation of adequate LAA closure at 1–3 months follow-up in 44% or 20%, respectively. The remaining 35% of patients continued OAC after LAAO as an adjunctive strategy. All LAAO patients were propensity-score matched and included in the primary outcome analysis. Baseline characteristics were well balanced after matching (Table 1). During follow up including 1406 patient-years (LAAO 1007; control 399) a total of 61 patients experienced an ischemic stroke: 2.2% per patient-year in LAAO group versus 9.8% per patient-year in the control group. LAAO was associated with a significantly lower risk of ischemic stroke (HR 0.33, 95% CI [0.19–0.59], p&amp;lt;0.001) compared to standard-of-care (Figure 1). Conclusion In this propensity-score matched study, LAAO was associated with a lower risk of ischemic stroke compared to standard-of-care in patients with a thrombo-embolic event and/or LAA thrombus despite OAC treatment. Randomized controlled trial data may further confirm the effectiveness of LAAO in this very high-risk population. Funding Acknowledgement Type of funding sources: None.

1590P Interest of preventive treatment with anticoagulant in older patients with cancer on venous thrombo-embolic events (ANTIGONE study): Design and baseline results

Venous thromboembolic events (VTE) are frequent during cancer and increase with age. Their preventions by anticoagulants in older patients with cancer has not been established and very few data exist in older frail subjects. The primary Objective: To compare the risk of VTE in older patients with cancer treated or not treated with preventive anticoagulant therapy. The secondary objectives are to assess the bleeding risk in both groups and to identify risk factors of VTE.

CO33 Methodological Challenges and Considerations for Decision Makers When Assessing within-Class Comparative Effectiveness and Cost-Effectiveness: The Case of Non-Vitamin K Antagonist Oral Anticoagulants

The United Kingdom National Institute of Health Care Excellence (NICE) published a draft clinical guideline for consultation on anticoagulation therapy for stroke prevention in individuals with atrial fibrillation in September 2020 that addressed which non-vitamin K antagonist oral anticoagulant (NOAC) therapy (apixaban, dabigatran, rivaroxaban, edoxaban) is most clinically and cost-effective. We aimed to elucidate methodological considerations and challenges involved in evaluating the comparative effectiveness and cost-effectiveness of within-class treatments for the purpose of decision making by a reimbursement authority.

Stroke Risk Stratification in Patients With Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting

BackgroundThe CHA2DS2‐VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, previous stroke or TIA [transient ischemic attack], vascular disease, age 65 to 74 years, sex category female; 2 indicates 2 points, otherwise 1 point) scoring system is recommended to guide decisions on oral anticoagulation therapy for stroke prevention in patients with nonsurgery atrial fibrillation. A score ≥1 in men and ≥2 in women, corresponding to an annual stroke risk exceeding 1%, warrants long‐term oral anticoagulation provided the bleeding risk is acceptable. However, in patients with new‐onset postoperative atrial fibrillation, the optimal risk stratification method is unknown. The aim of this study was therefore to evaluate the CHA2DS2‐VASc scoring system for estimating the 1‐year ischemic stroke risk in patients with new‐onset postoperative atrial fibrillation after coronary artery bypass grafting.Methods and ResultsAll patients with new‐onset postoperative atrial fibrillation and without oral anticoagulation after first‐time isolated coronary artery bypass grafting performed in Sweden during 2007 to 2017 were eligible for this registry‐based observational cohort study. The 1‐year ischemic stroke rate at each step of the CHA2DS2‐VASc score was estimated using a Kaplan‐Meier estimator. Of the 6368 patients included (mean age, 69.9 years; 81% men), >97% were treated with antiplatelet drugs. There were 147 ischemic strokes during the first year of follow‐up. The ischemic stroke rate at 1 year was 0.3%, 0.7%, and 1.5% in patients with CHA2DS2‐VASc scores of 1, 2, and 3, respectively, and ≥2.3% in patients with a score ≥4. A sensitivity analysis, with the inclusion of patients on anticoagulants, was performed and supported the primary results.ConclusionsPatients with new‐onset atrial fibrillation after coronary artery bypass grafting and a CHA2DS2‐VASc score <3 have such a low 1‐year risk for ischemic stroke that oral anticoagulation therapy should probably be avoided.