Regitse Lewis & Chrissie Entwistle, Specialist Physiotherapists
Ingrid Pabinger, Nick van Es, Georg Heinze, Florian Posch, Julia Riedl, Eva-Maria Reitter, Marcello Di Nisio, Gabriela Cesarman-Maus, Noémie Kraaijpoel, Christoph Carl Zielinski, Harry Roger Büller, Cihan Ay
The Lancet July 2018
Evensen LH, Isaksen T, Hindberg K, Braekkan SK, Hansen JB
Dalia M. Dawoud, David Wonderling, Jessica Glen, Sedina Lewis Xavier Griffin, Beverley J. Hunt, Gerard Stansby, Michael Reed, Nigel Rossiter, Jagjot Kaur Chahal, Carlos Sharpin and Peter Barry
Marian Knight, Kathryn Bunch, Derek Tuffnell, Hemali Jayakody, Judy Shakespeare, Rohit Kotnis, Sara Kenyon, Jennifer J Kurinczuk (Eds.)
Elderly people in good health should not take an aspirin a day, according to a major study in the US and Australia.
Melissa Ream, Adviser, Kent Surrey Sussex AHSN and AHSN Network AI Initiative, Tina Woods, Founder & CEO, Collider Health; Adviser to AHSN Network AI Initiative, Indra Joshi, Digital Health and AI Clinical Lead, NHS England, Laura Day, Analyst, KSS AHSN
Thrombosis Ireland, Ann-Marie O’Neill
According to findings from the phase 3 EINSTEIN-Jr study, treatment with rivaroxaban resulted in similar rates of recurrent venous thromboembolism (VTE) and bleeding when compared with standard anticoagulation among pediatric patients with previously diagnosed acute VTE who had started heparin therapy.
In the trial, children aged from birth to 17 years were randomized to receive either a body weight-adjusted dose of rivaroxaban (n=335) or standard of care therapy (low molecular weight heparin or fondaparinux, and/or vitamin K antagonist therapy; n=165).
Results of the study showed that the rate of symptomatic recurrent VTE – the primary end point – was similar in both treatment groups with 1.2% of patients experiencing a recurrent event in the rivaroxaban group compared with 3.0% in the standard anticoagulation group (hazard ratio [HR] 0.40; 95% CI, 0.11 to 1.41).
Findings also showed that 3.0% of the rivaroxaban group and 1.9% of the standard anticoagulation group experienced clinically relevant bleeding (HR 1.58; 95% CI, 0.51 to 6.27), which was the principal safety outcome of the trial.
“This trial examined for the first time whether a direct oral anticoagulant could alleviate the burden of blood clots in young patients, which would allow them to focus on recovering from their other health challenges,” said Christoph Male, MD, Department of Pediatrics, Medical University of Vienna, Vienna, Austria. “The EINSTEIN-Jr study with rivaroxaban represents a significant advance for pediatric VTE treatment.”
Currently, there is no direct oral anticoagulant approved for use in pediatric patients. The EINSTEIN-Jr study is 1 of 5 trials examining rivaroxaban use in pediatric patients. Another key study, UNIVERSE, is evaluating the safety and efficacy of rivaroxaban for thromboprophylaxis in children 2 to 8 years old after the Fontan procedure.
For more information visit janssen.com.
As part of Thrombosis UK's commitment in raising Awareness, Research and Care of Thrombosis. Our own Annya Stephens-Boal was part of the the research committee for the following new study.
Oral anticoagulants for primary prevention, treatment and secondary prevention of venous thromboembolic disease, and for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis and cost-effectiveness analysis
The study found that the use of novel oral anticoagulants has advantages over warfarin in patients with atrial fibrillation, but there was no strong evidence that they should replace warfarin or low-molecular-weight heparin in the primary prevention, treatment or secondary prevention of venous thromboembolic disease.
The number of patients being readmitted to hospital in an emergency with potentially preventable conditions such as pneumonia and pressure sores has grown significantly in the last seven years, analysis from The Nuffield Trust think tank shows today.
The new findings from QualityWatch, a major research programme from the Nuffield Trust and the Health Foundation, looked at hospital data detailing patient diagnoses and the reasons behind emergency hospital readmissions between 2010/11 and 2016/17. The analysis aims to highlight where improved quality of care in hospital or the community might have prevented readmission.
The analysis tracks a 19% rise in patients being readmitted to hospital in an emergency within 30 days of discharge between 2010/11 and 2016/17. Within this, the author identifies a 41.3% rise in emergency readmissions for conditions they classify as “potentially preventable”. These “potentially preventable” readmissions include patients with pneumonia, pressure sores and venous thromboembolism (VTE) and were conditions that patients were not diagnosed with when they were first admitted to hospital.
According to the author, these findings should raise questions about the quality of care that our elderly population are receiving during their hospital stay, how they are discharged from hospital and the quality of community and social care services.
While the findings may point towards changes in coding practices of conditions in hospital, as well as a rapidly growing frailer and older population, the findings show there is a good opportunity for local health providers and policy makers to target their quality improvement efforts.
Director of Research at the Nuffield Trust, Professor John Appleby said:
“Unnecessary trips and overnight stays in hospital put a strain on elderly patients and their families. That is why it’s concerning that our research shows the number of people being readmitted to hospital within 30 days with potentially preventable conditions is greater than it was seven years ago.”
Briefing author Jessica Morris, Research Analyst at the Nuffield Trust said:
“Emergency readmissions to hospital, for conditions that were not diagnosed during their first visit, are potentially a warning sign that a patient’s quality of care may have been compromised.
“The findings provide local health providers with a good opportunity to sit up and focus their attention and quality improvement initiatives on the three conditions where we’ve seen the most significant rise in readmissions.”
The Nuffield Trust has an in house ISDN line for radio interviews.
Read more about the work undertaken as a result of Thrombosis UK Travel Fellowship grant support:
Dr Colin Evans is a Postdoctoral Research Associate in the laboratory of Professor Randall Johnson at the Department of Physiology, Development and Neuroscience, University of Cambridge.
His current research investigates mechanisms that regulate the strong positive association between cancer and venous thrombosis - Read More
I am a Statistical Epidemiologist in the Cancer Epidemiology Unit, University of Oxford.
My current research investigates the relationship between cancer and venous thromboembolism using questionnaire data from a large UK cohort, the Million Women Study, linked to NHS hospital admissions records, cancer registrations and deaths - Read More
I am a 3rd Year PhD Student at the University of Aberdeen in Dr Nicola Mutch’s Lab.
My PhD project has focused on determining the role of platelets in fibrinolysis (the process of breaking down a blood clot). Our laboratory has found that proteins important in fibrinolysis and coagulation are retained on the surface of activated platelets in a protruding "cap" - Read More