The anticoagulant response to dabigatran, as measured by five coagulation laboratory assays, is consistent over childhood and comparable to the adult response, according to a research article published in Thrombosis Research.

In the in vitro study, lead author Dr. Kevin Dietrich of the University of Alberta, Canada, and his associates measured pooled plasma samples spiked with increasing concentrations of dabigatran from healthy children aged 0 to <1, 1 to <5, 5 to <10, 10 to <17 years, and adults. There were no differences in responses to dabigatran over all pediatric age groups, and these were comparable to adults.

The researchers found the dilute thrombin time (dTT) to be the most accurate measurement for assessing dabigatran concentrations in children and adults, as the ecarin time and TT were found to be overly sensitive.

“From a practical perspective, the dTT is an appropriate tool for measuring dabigatran concentrations. The dTT performed consistently across all age groups, and showed good reproducibility between repeat measurements and appropriate sensitivity and linearity of response within and above the therapeutic range,” they wrote.

For the full article, click here (Thrombosis Research 2015 [doi:10.1016/j.thromres.2015.01.017]).

The anticoagulant response to dabigatran, as measured by five coagulation laboratory assays, is consistent over childhood and comparable to the adult response, according to a research article published in Thrombosis Research.

In the in vitro study, lead author Dr. Kevin Dietrich of the University of Alberta, Canada, and his associates measured pooled plasma samples spiked with increasing concentrations of dabigatran from healthy children aged 0 to <1, 1 to <5, 5 to <10, 10 to <17 years, and adults. There were no differences in responses to dabigatran over all pediatric age groups, and these were comparable to adults.

The researchers found the dilute thrombin time (dTT) to be the most accurate measurement for assessing dabigatran concentrations in children and adults, as the ecarin time and TT were found to be overly sensitive.

“From a practical perspective, the dTT is an appropriate tool for measuring dabigatran concentrations. The dTT performed consistently across all age groups, and showed good reproducibility between repeat measurements and appropriate sensitivity and linearity of response within and above the therapeutic range,” they wrote.

For the full article, click here (Thrombosis Research 2015 [doi:10.1016/j.thromres.2015.01.017]).

The anticoagulant response to dabigatran, as measured by five coagulation laboratory assays, is consistent over childhood and comparable to the adult response, according to a research article published in Thrombosis Research.

In the in vitro study, lead author Dr. Kevin Dietrich of the University of Alberta, Canada, and his associates measured pooled plasma samples spiked with increasing concentrations of dabigatran from healthy children aged 0 to <1, 1 to <5, 5 to <10, 10 to <17 years, and adults. There were no differences in responses to dabigatran over all pediatric age groups, and these were comparable to adults.

The researchers found the dilute thrombin time (dTT) to be the most accurate measurement for assessing dabigatran concentrations in children and adults, as the ecarin time and TT were found to be overly sensitive.

“From a practical perspective, the dTT is an appropriate tool for measuring dabigatran concentrations. The dTT performed consistently across all age groups, and showed good reproducibility between repeat measurements and appropriate sensitivity and linearity of response within and above the therapeutic range,” they wrote.

For the full article, click here (Thrombosis Research 2015 [doi:10.1016/j.thromres.2015.01.017]).

Ablative fractional laser–assisted delivery of topical fluorouracil resulted in 100% histologic clearance in patients with squamous cell carcinoma in situ and 71% in patients with superficial basal cell carcinoma, based on data from 28 patients (mean age 71 years). Each patient underwent one pass with an ablative fractional laser, followed by one application of topical 5-FU 5% under occlusion for 7 days.

Histologic clearance and patient satisfaction were assessed 4-8 weeks after treatment; no serious adverse events were reported, and all patients said they would recommend the treatment to others.

“This treatment modality may be particularly useful for older patients, tumors located on lower extremities or back, and multiple tumors scattered on different areas of the body,” although controlled studies in diverse populations with longer follow-up times are needed, wrote Dr. Bichchau T. Nguyen of Tufts University, Boston, and colleagues (JAAD 2015; 72:558-60).

Read the full article from the Journal of the American Academy of Dermatology here.

Ablative fractional laser–assisted delivery of topical fluorouracil resulted in 100% histologic clearance in patients with squamous cell carcinoma in situ and 71% in patients with superficial basal cell carcinoma, based on data from 28 patients (mean age 71 years). Each patient underwent one pass with an ablative fractional laser, followed by one application of topical 5-FU 5% under occlusion for 7 days.

Histologic clearance and patient satisfaction were assessed 4-8 weeks after treatment; no serious adverse events were reported, and all patients said they would recommend the treatment to others.

“This treatment modality may be particularly useful for older patients, tumors located on lower extremities or back, and multiple tumors scattered on different areas of the body,” although controlled studies in diverse populations with longer follow-up times are needed, wrote Dr. Bichchau T. Nguyen of Tufts University, Boston, and colleagues (JAAD 2015; 72:558-60).

Read the full article from the Journal of the American Academy of Dermatology here.

Ablative fractional laser–assisted delivery of topical fluorouracil resulted in 100% histologic clearance in patients with squamous cell carcinoma in situ and 71% in patients with superficial basal cell carcinoma, based on data from 28 patients (mean age 71 years). Each patient underwent one pass with an ablative fractional laser, followed by one application of topical 5-FU 5% under occlusion for 7 days.

Histologic clearance and patient satisfaction were assessed 4-8 weeks after treatment; no serious adverse events were reported, and all patients said they would recommend the treatment to others.

“This treatment modality may be particularly useful for older patients, tumors located on lower extremities or back, and multiple tumors scattered on different areas of the body,” although controlled studies in diverse populations with longer follow-up times are needed, wrote Dr. Bichchau T. Nguyen of Tufts University, Boston, and colleagues (JAAD 2015; 72:558-60).

Read the full article from the Journal of the American Academy of Dermatology here.

An investigation of hospitalization costs for venous thromboembolism patients revealed that deep vein thrombosis (DVT) patients incurred an average cost of $1,594 per hospitalization day, while pulmonary embolism (PE) patients accounted for $1,735 per day. The costs stabilized on the third day for both groups, according to an investigation published in Thrombosis Research.

Joseph F. Dasta of the University of Texas College of Pharmacy, Round Rock, and his associates examined 28,953 DVT and 35,550 PE patients, identified from January 2009 to March 2013, in a longitudinal, cohort-based study. The mean lengths of stay for the DVT and PE cohorts were 4.7 days and 5.4 days, respectively. The room and board costs were the biggest, accounting for 40%-53% of the total costs of the DVT cohort and 38%-59% of the costs of the PE cohort, depending on the day. Pharmacy costs for both groups remained stable throughout the hospital stay.

The researchers noted that there may be a higher degree of severity in DVT patients vs. those with PE, as DVT patients had qualitatively higher surgery, supply, and pharmacy costs relative to PE patients. “The results of this study suggest that any change in treatment strategies or protocols that could effect [length of stay] may impact the hospitalization costs of DVT and PE populations,” they concluded.

Read more here: (Thromb. Res. 2015;135:303-10).

An investigation of hospitalization costs for venous thromboembolism patients revealed that deep vein thrombosis (DVT) patients incurred an average cost of $1,594 per hospitalization day, while pulmonary embolism (PE) patients accounted for $1,735 per day. The costs stabilized on the third day for both groups, according to an investigation published in Thrombosis Research.

Joseph F. Dasta of the University of Texas College of Pharmacy, Round Rock, and his associates examined 28,953 DVT and 35,550 PE patients, identified from January 2009 to March 2013, in a longitudinal, cohort-based study. The mean lengths of stay for the DVT and PE cohorts were 4.7 days and 5.4 days, respectively. The room and board costs were the biggest, accounting for 40%-53% of the total costs of the DVT cohort and 38%-59% of the costs of the PE cohort, depending on the day. Pharmacy costs for both groups remained stable throughout the hospital stay.

The researchers noted that there may be a higher degree of severity in DVT patients vs. those with PE, as DVT patients had qualitatively higher surgery, supply, and pharmacy costs relative to PE patients. “The results of this study suggest that any change in treatment strategies or protocols that could effect [length of stay] may impact the hospitalization costs of DVT and PE populations,” they concluded.

Read more here: (Thromb. Res. 2015;135:303-10).

An investigation of hospitalization costs for venous thromboembolism patients revealed that deep vein thrombosis (DVT) patients incurred an average cost of $1,594 per hospitalization day, while pulmonary embolism (PE) patients accounted for $1,735 per day. The costs stabilized on the third day for both groups, according to an investigation published in Thrombosis Research.

Joseph F. Dasta of the University of Texas College of Pharmacy, Round Rock, and his associates examined 28,953 DVT and 35,550 PE patients, identified from January 2009 to March 2013, in a longitudinal, cohort-based study. The mean lengths of stay for the DVT and PE cohorts were 4.7 days and 5.4 days, respectively. The room and board costs were the biggest, accounting for 40%-53% of the total costs of the DVT cohort and 38%-59% of the costs of the PE cohort, depending on the day. Pharmacy costs for both groups remained stable throughout the hospital stay.

The researchers noted that there may be a higher degree of severity in DVT patients vs. those with PE, as DVT patients had qualitatively higher surgery, supply, and pharmacy costs relative to PE patients. “The results of this study suggest that any change in treatment strategies or protocols that could effect [length of stay] may impact the hospitalization costs of DVT and PE populations,” they concluded.

Read more here: (Thromb. Res. 2015;135:303-10).

Adding an ablative fractional laser to daylight-assisted photodynamic therapy significantly improved the clearance rate of actinic keratoses in organ transplant recipients, compared with daylight PDT alone, conventional PDT alone, or ablative fractional laser alone, based on data from the treatment of 542 AKs in 16 adult patients reported by Dr. Katrine Togsverd-Bo of the University of Copenhagen, Denmark, and her colleagues (Br. J. Dermatol. 2015;172:467-74).

Each patient underwent each of the four treatment modalities on four randomized areas on the same region of the body. Three months after treatment, AK clearance rates were 74% for the combination AFL-dPDT, compared with 46% for daylight PDT alone, 50% for conventional PDT alone, and 5% for ablative fractional laser alone (P < .001).

Read the full article from the British Journal of Dermatology here.

Adding an ablative fractional laser to daylight-assisted photodynamic therapy significantly improved the clearance rate of actinic keratoses in organ transplant recipients, compared with daylight PDT alone, conventional PDT alone, or ablative fractional laser alone, based on data from the treatment of 542 AKs in 16 adult patients reported by Dr. Katrine Togsverd-Bo of the University of Copenhagen, Denmark, and her colleagues (Br. J. Dermatol. 2015;172:467-74).

Each patient underwent each of the four treatment modalities on four randomized areas on the same region of the body. Three months after treatment, AK clearance rates were 74% for the combination AFL-dPDT, compared with 46% for daylight PDT alone, 50% for conventional PDT alone, and 5% for ablative fractional laser alone (P < .001).

Read the full article from the British Journal of Dermatology here.

Adding an ablative fractional laser to daylight-assisted photodynamic therapy significantly improved the clearance rate of actinic keratoses in organ transplant recipients, compared with daylight PDT alone, conventional PDT alone, or ablative fractional laser alone, based on data from the treatment of 542 AKs in 16 adult patients reported by Dr. Katrine Togsverd-Bo of the University of Copenhagen, Denmark, and her colleagues (Br. J. Dermatol. 2015;172:467-74).

Each patient underwent each of the four treatment modalities on four randomized areas on the same region of the body. Three months after treatment, AK clearance rates were 74% for the combination AFL-dPDT, compared with 46% for daylight PDT alone, 50% for conventional PDT alone, and 5% for ablative fractional laser alone (P < .001).

Read the full article from the British Journal of Dermatology here.

There were no significant differences between the anticoagulants rivaroxaban (Xarelto) and enoxaparin (Lovenox) in terms of venous thromboembolism prophylaxis, infection, reoperation, transfusion, or major bleeding complications after primary hip and knee arthroplasty, according to a study published in the Journal of Arthroplasty.

In a non–industry-funded retrospective cohort study, Dr. Michael A. Charters of Henry Ford Health System in Detroit and his associates looked at 2,406 patients who underwent total hip and knee arthroplasty between 2009 and 2011. Of the 1,762 patients ultimately included in the study, 1,113 (63.2%) received enoxaparin and 649 (36.8%) received rivaroxaban for VTE prophylaxis. The deep venous thrombosis rate of the enoxaparin group was 1.8%, compared with 0.9% in the rivaroxaban group (P = .208) and the pulmonary embolism rate of the enoxaparin group was 0.7%, compared with 0.3% in the rivaroxaban group (P = .437).

“For standard primary THA [total hip arthroplasty] and TKA [total knee arthroplasty], these medications appear to be equally effective without increased adverse events,” the researchers said.

Read the full article at: The Journal of Arthoplasty 2015 (www.arthroplastyjournal.org/article/S0883-5403%2815%2900120-5/abstract).

There were no significant differences between the anticoagulants rivaroxaban (Xarelto) and enoxaparin (Lovenox) in terms of venous thromboembolism prophylaxis, infection, reoperation, transfusion, or major bleeding complications after primary hip and knee arthroplasty, according to a study published in the Journal of Arthroplasty.

In a non–industry-funded retrospective cohort study, Dr. Michael A. Charters of Henry Ford Health System in Detroit and his associates looked at 2,406 patients who underwent total hip and knee arthroplasty between 2009 and 2011. Of the 1,762 patients ultimately included in the study, 1,113 (63.2%) received enoxaparin and 649 (36.8%) received rivaroxaban for VTE prophylaxis. The deep venous thrombosis rate of the enoxaparin group was 1.8%, compared with 0.9% in the rivaroxaban group (P = .208) and the pulmonary embolism rate of the enoxaparin group was 0.7%, compared with 0.3% in the rivaroxaban group (P = .437).

“For standard primary THA [total hip arthroplasty] and TKA [total knee arthroplasty], these medications appear to be equally effective without increased adverse events,” the researchers said.

Read the full article at: The Journal of Arthoplasty 2015 (www.arthroplastyjournal.org/article/S0883-5403%2815%2900120-5/abstract).

There were no significant differences between the anticoagulants rivaroxaban (Xarelto) and enoxaparin (Lovenox) in terms of venous thromboembolism prophylaxis, infection, reoperation, transfusion, or major bleeding complications after primary hip and knee arthroplasty, according to a study published in the Journal of Arthroplasty.

In a non–industry-funded retrospective cohort study, Dr. Michael A. Charters of Henry Ford Health System in Detroit and his associates looked at 2,406 patients who underwent total hip and knee arthroplasty between 2009 and 2011. Of the 1,762 patients ultimately included in the study, 1,113 (63.2%) received enoxaparin and 649 (36.8%) received rivaroxaban for VTE prophylaxis. The deep venous thrombosis rate of the enoxaparin group was 1.8%, compared with 0.9% in the rivaroxaban group (P = .208) and the pulmonary embolism rate of the enoxaparin group was 0.7%, compared with 0.3% in the rivaroxaban group (P = .437).

“For standard primary THA [total hip arthroplasty] and TKA [total knee arthroplasty], these medications appear to be equally effective without increased adverse events,” the researchers said.

Read the full article at: The Journal of Arthoplasty 2015 (www.arthroplastyjournal.org/article/S0883-5403%2815%2900120-5/abstract).

PHOENIX – Trauma patients probably need an elevated dose of enoxaparin – perhaps 40 mg twice daily – to prevent venous thromboembolisms, according to a prospective study of 85 trauma patients at the Palmetto Health Richland hospital in Columbia, S.C.

Also, antifactor 10a – a blood test often used in research to gauge how well enoxaparin (Lovenox) is thinning the blood – doesn’t work very well as an empiric measure of anticoagulation; thromboelastography (TEG) may be better, lead investigator Janise Phillips, Pharm.D., said at the Critical Care Congress, sponsored by the Society of Critical Care Medicine.

Her team tracked trauma patients who had at least three consecutive doses of enoxaparin prophylaxis for venous thromboembolism (VTE) and at least one peak antifactor 10a level drawn; enoxaparin doses were adjusted as needed to hit a weekly antifactor 10a level of 0.20-0.40 IU/mL, which is thought to be the therapeutic range for enoxaparin. Patients were in the ICU for a median of about 10 days, and in the hospital for about 2-3 weeks.

The types of trauma were not reported in the study, but the investigation confirms prior findings that critically ill trauma patients – and perhaps burn patients – need higher anticoagulant doses.

Overall, 65% (13) of patients on an initial enoxaparin regimen of 30 mg subcutaneously twice daily were below anti-factor 10a levels of 0.20-0.40 IU/mL after their first dose; 22% (8) were subtherapeutic after an initial dose of 40 mg once daily; and 21% (6) were subtherapeutic after an initial dose of 40 mg twice daily.

Antifactor 10a levels didn’t match well with clinical benefit. VTEs were diagnosed in 15% (4) of patients with an initial subtherapeutic antifactor 10a level, but 15% (4) bled on their subtherapeutic dose; 8.5% (4) of patients with an initial therapeutic level had a VTE, vs. none who were supratherapeutic after their initial dose. However, 9% (1) of supratherapeutic patients had an enoxaparin bleed.

“These were trauma patients in and out of surgery. A lot of the time, we had to stop the dose and hold it, which may” explain why subtherapeutic patients had the highest VTE risk, said Dr. Phillips, now a critical care pharmacist at the Cleveland Clinic hospital in Abu Dhabi, United Arab Emirates.

More than half of the patients were men, and being male was the only factor that seemed to increase the risk of subtherapeutic enoxaparin levels (P = .04). There was a trend for subtherapeutic levels in heavier patients – which might help explain the higher risk in men – and those with diminished kidney function. Even so, the fact that both VTEs and bleeding were most likely in underdosed patients could mean that antifactor 10a “is really not the best marker for VTE risk. At $80 a pop, it isn’t cost-effective, and [even] patients with therapeutic levels ended up with clots. TEG gives you a real time view of the coagulation status of the patient,” and may be the way to go, Dr. Phillips said.

[email protected]

PHOENIX – Trauma patients probably need an elevated dose of enoxaparin – perhaps 40 mg twice daily – to prevent venous thromboembolisms, according to a prospective study of 85 trauma patients at the Palmetto Health Richland hospital in Columbia, S.C.

Also, antifactor 10a – a blood test often used in research to gauge how well enoxaparin (Lovenox) is thinning the blood – doesn’t work very well as an empiric measure of anticoagulation; thromboelastography (TEG) may be better, lead investigator Janise Phillips, Pharm.D., said at the Critical Care Congress, sponsored by the Society of Critical Care Medicine.

Her team tracked trauma patients who had at least three consecutive doses of enoxaparin prophylaxis for venous thromboembolism (VTE) and at least one peak antifactor 10a level drawn; enoxaparin doses were adjusted as needed to hit a weekly antifactor 10a level of 0.20-0.40 IU/mL, which is thought to be the therapeutic range for enoxaparin. Patients were in the ICU for a median of about 10 days, and in the hospital for about 2-3 weeks.

The types of trauma were not reported in the study, but the investigation confirms prior findings that critically ill trauma patients – and perhaps burn patients – need higher anticoagulant doses.

Overall, 65% (13) of patients on an initial enoxaparin regimen of 30 mg subcutaneously twice daily were below anti-factor 10a levels of 0.20-0.40 IU/mL after their first dose; 22% (8) were subtherapeutic after an initial dose of 40 mg once daily; and 21% (6) were subtherapeutic after an initial dose of 40 mg twice daily.

Antifactor 10a levels didn’t match well with clinical benefit. VTEs were diagnosed in 15% (4) of patients with an initial subtherapeutic antifactor 10a level, but 15% (4) bled on their subtherapeutic dose; 8.5% (4) of patients with an initial therapeutic level had a VTE, vs. none who were supratherapeutic after their initial dose. However, 9% (1) of supratherapeutic patients had an enoxaparin bleed.

“These were trauma patients in and out of surgery. A lot of the time, we had to stop the dose and hold it, which may” explain why subtherapeutic patients had the highest VTE risk, said Dr. Phillips, now a critical care pharmacist at the Cleveland Clinic hospital in Abu Dhabi, United Arab Emirates.

More than half of the patients were men, and being male was the only factor that seemed to increase the risk of subtherapeutic enoxaparin levels (P = .04). There was a trend for subtherapeutic levels in heavier patients – which might help explain the higher risk in men – and those with diminished kidney function. Even so, the fact that both VTEs and bleeding were most likely in underdosed patients could mean that antifactor 10a “is really not the best marker for VTE risk. At $80 a pop, it isn’t cost-effective, and [even] patients with therapeutic levels ended up with clots. TEG gives you a real time view of the coagulation status of the patient,” and may be the way to go, Dr. Phillips said.

[email protected]

PHOENIX – Trauma patients probably need an elevated dose of enoxaparin – perhaps 40 mg twice daily – to prevent venous thromboembolisms, according to a prospective study of 85 trauma patients at the Palmetto Health Richland hospital in Columbia, S.C.

Also, antifactor 10a – a blood test often used in research to gauge how well enoxaparin (Lovenox) is thinning the blood – doesn’t work very well as an empiric measure of anticoagulation; thromboelastography (TEG) may be better, lead investigator Janise Phillips, Pharm.D., said at the Critical Care Congress, sponsored by the Society of Critical Care Medicine.

Her team tracked trauma patients who had at least three consecutive doses of enoxaparin prophylaxis for venous thromboembolism (VTE) and at least one peak antifactor 10a level drawn; enoxaparin doses were adjusted as needed to hit a weekly antifactor 10a level of 0.20-0.40 IU/mL, which is thought to be the therapeutic range for enoxaparin. Patients were in the ICU for a median of about 10 days, and in the hospital for about 2-3 weeks.

The types of trauma were not reported in the study, but the investigation confirms prior findings that critically ill trauma patients – and perhaps burn patients – need higher anticoagulant doses.

Overall, 65% (13) of patients on an initial enoxaparin regimen of 30 mg subcutaneously twice daily were below anti-factor 10a levels of 0.20-0.40 IU/mL after their first dose; 22% (8) were subtherapeutic after an initial dose of 40 mg once daily; and 21% (6) were subtherapeutic after an initial dose of 40 mg twice daily.

Antifactor 10a levels didn’t match well with clinical benefit. VTEs were diagnosed in 15% (4) of patients with an initial subtherapeutic antifactor 10a level, but 15% (4) bled on their subtherapeutic dose; 8.5% (4) of patients with an initial therapeutic level had a VTE, vs. none who were supratherapeutic after their initial dose. However, 9% (1) of supratherapeutic patients had an enoxaparin bleed.

“These were trauma patients in and out of surgery. A lot of the time, we had to stop the dose and hold it, which may” explain why subtherapeutic patients had the highest VTE risk, said Dr. Phillips, now a critical care pharmacist at the Cleveland Clinic hospital in Abu Dhabi, United Arab Emirates.

More than half of the patients were men, and being male was the only factor that seemed to increase the risk of subtherapeutic enoxaparin levels (P = .04). There was a trend for subtherapeutic levels in heavier patients – which might help explain the higher risk in men – and those with diminished kidney function. Even so, the fact that both VTEs and bleeding were most likely in underdosed patients could mean that antifactor 10a “is really not the best marker for VTE risk. At $80 a pop, it isn’t cost-effective, and [even] patients with therapeutic levels ended up with clots. TEG gives you a real time view of the coagulation status of the patient,” and may be the way to go, Dr. Phillips said.

[email protected]

The risk of inflammatory bowel disease (IBD) patients developing deep vein thrombosis and pulmonary embolism was 1.98-fold and 1.80-fold higher, respectively, than those without the disease, according to research published in Thrombosis Research.

To explore the connection between deep vein thrombosis (DVT) and IBD, Dr. Wei-Sheng Chung of Taichung (Taiwan) Hospital and associates compared 11,445 IBD patients and 45,780 controls in a nationwide, population-based cohort study.

The IBD patients had a higher prevalence of comorbidities than their peers, including atrial fibrillation, hypertension, diabetes, heart failure, and cerebral vascular disease. In addition, the IBD patients who were hospitalized twice per year exhibited a significantly greater risk of developing DVT (adjusted hazard ratio, 32.9; 95% confidence interval, 20.5-52.8) and pulmonary embolism (adjusted HR, 24.2; 95% CI, 11.1-52.9) than did the comparison cohort.

Read more here: (Thromb. Res. 2015;135:492-6 [http://dx.doi.org/10.1016/j.thromres.2014.12.025]).

The risk of inflammatory bowel disease (IBD) patients developing deep vein thrombosis and pulmonary embolism was 1.98-fold and 1.80-fold higher, respectively, than those without the disease, according to research published in Thrombosis Research.

To explore the connection between deep vein thrombosis (DVT) and IBD, Dr. Wei-Sheng Chung of Taichung (Taiwan) Hospital and associates compared 11,445 IBD patients and 45,780 controls in a nationwide, population-based cohort study.

The IBD patients had a higher prevalence of comorbidities than their peers, including atrial fibrillation, hypertension, diabetes, heart failure, and cerebral vascular disease. In addition, the IBD patients who were hospitalized twice per year exhibited a significantly greater risk of developing DVT (adjusted hazard ratio, 32.9; 95% confidence interval, 20.5-52.8) and pulmonary embolism (adjusted HR, 24.2; 95% CI, 11.1-52.9) than did the comparison cohort.

Read more here: (Thromb. Res. 2015;135:492-6 [http://dx.doi.org/10.1016/j.thromres.2014.12.025]).

The risk of inflammatory bowel disease (IBD) patients developing deep vein thrombosis and pulmonary embolism was 1.98-fold and 1.80-fold higher, respectively, than those without the disease, according to research published in Thrombosis Research.

To explore the connection between deep vein thrombosis (DVT) and IBD, Dr. Wei-Sheng Chung of Taichung (Taiwan) Hospital and associates compared 11,445 IBD patients and 45,780 controls in a nationwide, population-based cohort study.

The IBD patients had a higher prevalence of comorbidities than their peers, including atrial fibrillation, hypertension, diabetes, heart failure, and cerebral vascular disease. In addition, the IBD patients who were hospitalized twice per year exhibited a significantly greater risk of developing DVT (adjusted hazard ratio, 32.9; 95% confidence interval, 20.5-52.8) and pulmonary embolism (adjusted HR, 24.2; 95% CI, 11.1-52.9) than did the comparison cohort.

Read more here: (Thromb. Res. 2015;135:492-6 [http://dx.doi.org/10.1016/j.thromres.2014.12.025]).

Prescription medications

Photo by Steven Harbour

Researchers say they have discovered a new subtype of acute lymphoblastic leukemia (ALL) that is sensitive to drugs already approved to treat other hematologic malignancies.

The team uncovered cases of ALL that were dependent upon tonic pre-B-cell-receptor (BCR) signaling and therefore sensitive to drugs that inhibit tyrosine kinases downstream of the pre-BCR.

The group also developed a test that can identify patients with this subtype of ALL.

“We hope patients in this newly identified subset can be treated with these targeted drugs, . . . which are powerfully effective in the mouse experiments we have conducted on ALL,” said Markus Müschen, MD, PhD, of the University of California, San Francisco.

Dr Müschen and his colleagues described this work in Cancer Cell.

The researchers studied samples from 830 patients enrolled in 4 ongoing ALL trials and found tonic pre-BCR signaling in 112 patients (13.5%). Virtually all of the bone marrow slices from these patients showed “beautiful staining” of BCL6 expression, Dr Müschen said. (Two of the patients had weak staining.)

On the other hand, no BCL6 staining was observed in patients lacking pre-BCR signaling. These results suggest that BCL6 is a biomarker for pre-BCR signaling. And by testing patients for BCL6, we may be able to identify those who will respond to treatment with pre-BCR signaling inhibitors, the researchers said.

The team tested a range of pre-BCR signaling inhibitors in vitro. And they found a few compounds that were effective against pre-BCR⁺ ALL—the SYK inhibitor PRT062607, the BTK inhibitor ibrutinib, the SRC inhibitor dasatinib, and the PIK3δ inhibitor idelalisib.

Subsequent experiments revealed that dasatinib had the strongest antileukemic effect, so the researchers tested the drug in mouse models of pre-BCR⁺ ALL. Dasatinib significantly delayed leukemic expansion and prolonged overall survival in some mice, while completely eradicating the disease in other mice.

Dr Müschen said that dasatinib and other pre-BCR signaling inhibitors may be able to reduce the amount of conventional chemotherapy given to patients with pre-BCR⁺ ALL, or even replace chemotherapy altogether.

“In our experiments with mice, both combination therapy with low-dose chemotherapy and single-agent targeted therapy each worked very well,” he said.

Prescription medications

Photo by Steven Harbour

Researchers say they have discovered a new subtype of acute lymphoblastic leukemia (ALL) that is sensitive to drugs already approved to treat other hematologic malignancies.

The team uncovered cases of ALL that were dependent upon tonic pre-B-cell-receptor (BCR) signaling and therefore sensitive to drugs that inhibit tyrosine kinases downstream of the pre-BCR.

The group also developed a test that can identify patients with this subtype of ALL.

“We hope patients in this newly identified subset can be treated with these targeted drugs, . . . which are powerfully effective in the mouse experiments we have conducted on ALL,” said Markus Müschen, MD, PhD, of the University of California, San Francisco.

Dr Müschen and his colleagues described this work in Cancer Cell.

The researchers studied samples from 830 patients enrolled in 4 ongoing ALL trials and found tonic pre-BCR signaling in 112 patients (13.5%). Virtually all of the bone marrow slices from these patients showed “beautiful staining” of BCL6 expression, Dr Müschen said. (Two of the patients had weak staining.)

On the other hand, no BCL6 staining was observed in patients lacking pre-BCR signaling. These results suggest that BCL6 is a biomarker for pre-BCR signaling. And by testing patients for BCL6, we may be able to identify those who will respond to treatment with pre-BCR signaling inhibitors, the researchers said.

The team tested a range of pre-BCR signaling inhibitors in vitro. And they found a few compounds that were effective against pre-BCR⁺ ALL—the SYK inhibitor PRT062607, the BTK inhibitor ibrutinib, the SRC inhibitor dasatinib, and the PIK3δ inhibitor idelalisib.

Subsequent experiments revealed that dasatinib had the strongest antileukemic effect, so the researchers tested the drug in mouse models of pre-BCR⁺ ALL. Dasatinib significantly delayed leukemic expansion and prolonged overall survival in some mice, while completely eradicating the disease in other mice.

Dr Müschen said that dasatinib and other pre-BCR signaling inhibitors may be able to reduce the amount of conventional chemotherapy given to patients with pre-BCR⁺ ALL, or even replace chemotherapy altogether.

“In our experiments with mice, both combination therapy with low-dose chemotherapy and single-agent targeted therapy each worked very well,” he said.

Prescription medications

Photo by Steven Harbour

Researchers say they have discovered a new subtype of acute lymphoblastic leukemia (ALL) that is sensitive to drugs already approved to treat other hematologic malignancies.

The team uncovered cases of ALL that were dependent upon tonic pre-B-cell-receptor (BCR) signaling and therefore sensitive to drugs that inhibit tyrosine kinases downstream of the pre-BCR.

The group also developed a test that can identify patients with this subtype of ALL.

“We hope patients in this newly identified subset can be treated with these targeted drugs, . . . which are powerfully effective in the mouse experiments we have conducted on ALL,” said Markus Müschen, MD, PhD, of the University of California, San Francisco.

Dr Müschen and his colleagues described this work in Cancer Cell.

The researchers studied samples from 830 patients enrolled in 4 ongoing ALL trials and found tonic pre-BCR signaling in 112 patients (13.5%). Virtually all of the bone marrow slices from these patients showed “beautiful staining” of BCL6 expression, Dr Müschen said. (Two of the patients had weak staining.)

On the other hand, no BCL6 staining was observed in patients lacking pre-BCR signaling. These results suggest that BCL6 is a biomarker for pre-BCR signaling. And by testing patients for BCL6, we may be able to identify those who will respond to treatment with pre-BCR signaling inhibitors, the researchers said.

The team tested a range of pre-BCR signaling inhibitors in vitro. And they found a few compounds that were effective against pre-BCR⁺ ALL—the SYK inhibitor PRT062607, the BTK inhibitor ibrutinib, the SRC inhibitor dasatinib, and the PIK3δ inhibitor idelalisib.

Subsequent experiments revealed that dasatinib had the strongest antileukemic effect, so the researchers tested the drug in mouse models of pre-BCR⁺ ALL. Dasatinib significantly delayed leukemic expansion and prolonged overall survival in some mice, while completely eradicating the disease in other mice.

Dr Müschen said that dasatinib and other pre-BCR signaling inhibitors may be able to reduce the amount of conventional chemotherapy given to patients with pre-BCR⁺ ALL, or even replace chemotherapy altogether.

“In our experiments with mice, both combination therapy with low-dose chemotherapy and single-agent targeted therapy each worked very well,” he said.

Micrograph showing MF

Image by Peter Anderson

Results of a phase 3 trial suggest the JAK2/FLT3 inhibitor pacritinib may be more effective for patients with myelofibrosis (MF) than best available therapy (BAT), excluding JAK inhibitors.

Patients who received pacritinib were more likely than those who received BAT to see a reduction in spleen volume and to become transfusion-independent,

regardless of their platelet counts.

In fact, pacritinib proved particularly effective among patients with severe thrombocytopenia.

CTI Biopharma and Baxter International, Inc., the companies developing pacritinib, announced these results from the PERSIST-1 trial yesterday.

“Despite the introduction of JAK2 inhibitors as effective therapies for patients with myelofibrosis, there remains a treatment gap for patients with disease-related or treatment-emergent thrombocytopenia,” said study investigator Claire Harrison, MD, of Guy’s Hospital in London, UK.

“The currently approved drug [ruxolitinib] may require dose titration to less effective doses in this patient population, thus limiting our ability to effectively treat them. Results from the PERSIST-1 randomized trial demonstrate that pacritinib could address this unmet medical need.”

PERSIST-1 is a randomized (2:1), phase 3 trial comparing the safety and efficacy of pacritinib to BAT, other than JAK inhibitors. Investigators enrolled 327 patients with primary and secondary MF, post-polycythemia vera MF, or post-essential thrombocythemia MF.

The study’s primary endpoint was the proportion of patients achieving a 35% or greater reduction in spleen volume from baseline to week 24, as measured by MRI or CT, when compared with BAT. Once patients completed 24 weeks of treatment, or if their disease progressed, they could cross over from the BAT arm to the pacritinib arm.

Investigators found that PERSIST-1 met its primary endpoint in the intent-to-treat population. Pacritinib produced a significantly better rate of spleen volume reduction (P=0.0003) when compared to BAT.

The same was true among patients with platelet counts of less than 100,000/μL and less than 50,000/μL, both subgroups that were stratified at randomization.

The magnitude of treatment effect was consistent with previously reported phase 2 results, with the greatest reduction observed among the sickest patients (platelet counts <50,000/μL).

Fifty patients were transfusion-dependent at study entry (receiving ≥ 6 units of red blood cells over 90 days pre-entry). And, compared to BAT, pacritinib resulted in a clinically meaningful percentage of patients becoming transfusion-independent.

Ultimately, 79% of patients in the BAT arm crossed over to the pacritinib arm.

Investigators said the safety profile in the PERSIST-1 trial was consistent with prior phase 2 trials, as the most common treatment-emergent adverse events were diarrhea, nausea, and vomiting. However, the incidence of grade 3 events was lower than previously observed in phase 2 trials. And no grade 4 gastrointestinal adverse events were reported.

Three patients discontinued treatment with pacritinib, and 9 required dose reductions for diarrhea. A preliminary analysis suggested that few patients discontinued pacritinib or required a dose reduction due to treatment-related anemia or thrombocytopenia.

Additional data from ongoing analyses will be submitted for presentation at an upcoming scientific meeting, according to Baxter and CTI Biopharma.

Micrograph showing MF

Image by Peter Anderson

Results of a phase 3 trial suggest the JAK2/FLT3 inhibitor pacritinib may be more effective for patients with myelofibrosis (MF) than best available therapy (BAT), excluding JAK inhibitors.

Patients who received pacritinib were more likely than those who received BAT to see a reduction in spleen volume and to become transfusion-independent,

regardless of their platelet counts.

In fact, pacritinib proved particularly effective among patients with severe thrombocytopenia.

CTI Biopharma and Baxter International, Inc., the companies developing pacritinib, announced these results from the PERSIST-1 trial yesterday.

“Despite the introduction of JAK2 inhibitors as effective therapies for patients with myelofibrosis, there remains a treatment gap for patients with disease-related or treatment-emergent thrombocytopenia,” said study investigator Claire Harrison, MD, of Guy’s Hospital in London, UK.

“The currently approved drug [ruxolitinib] may require dose titration to less effective doses in this patient population, thus limiting our ability to effectively treat them. Results from the PERSIST-1 randomized trial demonstrate that pacritinib could address this unmet medical need.”

PERSIST-1 is a randomized (2:1), phase 3 trial comparing the safety and efficacy of pacritinib to BAT, other than JAK inhibitors. Investigators enrolled 327 patients with primary and secondary MF, post-polycythemia vera MF, or post-essential thrombocythemia MF.

The study’s primary endpoint was the proportion of patients achieving a 35% or greater reduction in spleen volume from baseline to week 24, as measured by MRI or CT, when compared with BAT. Once patients completed 24 weeks of treatment, or if their disease progressed, they could cross over from the BAT arm to the pacritinib arm.

Investigators found that PERSIST-1 met its primary endpoint in the intent-to-treat population. Pacritinib produced a significantly better rate of spleen volume reduction (P=0.0003) when compared to BAT.

The same was true among patients with platelet counts of less than 100,000/μL and less than 50,000/μL, both subgroups that were stratified at randomization.

The magnitude of treatment effect was consistent with previously reported phase 2 results, with the greatest reduction observed among the sickest patients (platelet counts <50,000/μL).

Fifty patients were transfusion-dependent at study entry (receiving ≥ 6 units of red blood cells over 90 days pre-entry). And, compared to BAT, pacritinib resulted in a clinically meaningful percentage of patients becoming transfusion-independent.

Ultimately, 79% of patients in the BAT arm crossed over to the pacritinib arm.

Investigators said the safety profile in the PERSIST-1 trial was consistent with prior phase 2 trials, as the most common treatment-emergent adverse events were diarrhea, nausea, and vomiting. However, the incidence of grade 3 events was lower than previously observed in phase 2 trials. And no grade 4 gastrointestinal adverse events were reported.

Three patients discontinued treatment with pacritinib, and 9 required dose reductions for diarrhea. A preliminary analysis suggested that few patients discontinued pacritinib or required a dose reduction due to treatment-related anemia or thrombocytopenia.

Additional data from ongoing analyses will be submitted for presentation at an upcoming scientific meeting, according to Baxter and CTI Biopharma.

Micrograph showing MF

Image by Peter Anderson

Results of a phase 3 trial suggest the JAK2/FLT3 inhibitor pacritinib may be more effective for patients with myelofibrosis (MF) than best available therapy (BAT), excluding JAK inhibitors.

Patients who received pacritinib were more likely than those who received BAT to see a reduction in spleen volume and to become transfusion-independent,

regardless of their platelet counts.

In fact, pacritinib proved particularly effective among patients with severe thrombocytopenia.

CTI Biopharma and Baxter International, Inc., the companies developing pacritinib, announced these results from the PERSIST-1 trial yesterday.

“Despite the introduction of JAK2 inhibitors as effective therapies for patients with myelofibrosis, there remains a treatment gap for patients with disease-related or treatment-emergent thrombocytopenia,” said study investigator Claire Harrison, MD, of Guy’s Hospital in London, UK.

“The currently approved drug [ruxolitinib] may require dose titration to less effective doses in this patient population, thus limiting our ability to effectively treat them. Results from the PERSIST-1 randomized trial demonstrate that pacritinib could address this unmet medical need.”

PERSIST-1 is a randomized (2:1), phase 3 trial comparing the safety and efficacy of pacritinib to BAT, other than JAK inhibitors. Investigators enrolled 327 patients with primary and secondary MF, post-polycythemia vera MF, or post-essential thrombocythemia MF.

The study’s primary endpoint was the proportion of patients achieving a 35% or greater reduction in spleen volume from baseline to week 24, as measured by MRI or CT, when compared with BAT. Once patients completed 24 weeks of treatment, or if their disease progressed, they could cross over from the BAT arm to the pacritinib arm.

Investigators found that PERSIST-1 met its primary endpoint in the intent-to-treat population. Pacritinib produced a significantly better rate of spleen volume reduction (P=0.0003) when compared to BAT.

The same was true among patients with platelet counts of less than 100,000/μL and less than 50,000/μL, both subgroups that were stratified at randomization.

The magnitude of treatment effect was consistent with previously reported phase 2 results, with the greatest reduction observed among the sickest patients (platelet counts <50,000/μL).

Fifty patients were transfusion-dependent at study entry (receiving ≥ 6 units of red blood cells over 90 days pre-entry). And, compared to BAT, pacritinib resulted in a clinically meaningful percentage of patients becoming transfusion-independent.

Ultimately, 79% of patients in the BAT arm crossed over to the pacritinib arm.

Investigators said the safety profile in the PERSIST-1 trial was consistent with prior phase 2 trials, as the most common treatment-emergent adverse events were diarrhea, nausea, and vomiting. However, the incidence of grade 3 events was lower than previously observed in phase 2 trials. And no grade 4 gastrointestinal adverse events were reported.

Three patients discontinued treatment with pacritinib, and 9 required dose reductions for diarrhea. A preliminary analysis suggested that few patients discontinued pacritinib or required a dose reduction due to treatment-related anemia or thrombocytopenia.

Additional data from ongoing analyses will be submitted for presentation at an upcoming scientific meeting, according to Baxter and CTI Biopharma.

Doctor and patient

Photo courtesy of CDC

The American Society of Hematology (ASH) has released a report proposing a new role for hematologists specializing in non-malignant blood disorders.

ASH partnered with the healthcare consulting firm The Lewin Group to identify emerging career opportunities for health system- and hospital-based hematologists and to provide guidance on pursuing those opportunities.

The resulting report, published in Blood, outlines a few models for a systems-based clinical hematologist.

The report’s authors noted that demand for hematology expertise remains high nationwide. However, ASH and its members are concerned that changes to academic training will hinder both the recruitment of new talent to the field and the retention of seasoned experts.

The authors said that today’s hematology trainees are unlikely to receive the same non-malignant training as many “classic” hematologists trained in prior decades. And training shortfalls are further compounded by the fact that primary care physicians do not have the expertise to manage common blood disorders, which increases referrals to hematologists.

This results in higher demand for a smaller pool of hematologists entering the field with adequate training to effectively and efficiently manage non-malignant disorders.

“Given the rapid evolution and complexity of the field, the time is appropriate to identify career pathways that attract and enable physicians to practice non-malignant hematology in a sustainable manner,” said author Janis L. Abkowitz, MD, of the University of Washington in Seattle.

She and her colleagues noted that, in response to these challenges, US hematologists are defining new paths and assuming more centralized positions in large and small healthcare systems.

These systems-based hematologists are specialty-trained physicians—employed by a hospital, medical center, or health system—who optimize individual patient care as well as the overall system of healthcare delivery for patients with blood disorders.

For example, a systems-based hematologist could work closely with surgeons to minimize perioperative bleeding and could manage care pathways for patients with chronic blood diseases.

The report offered 4 examples where the involvement of a systems-based hematologist would lead to cost-effective decision-making. These were based upon interviews with 14 early adoptors of the systems-based approach to hematology.

The first example was heparin-induced thrombocytopenia (HIT). A systems-based hematologist could implement care pathways that focus on HIT by working to reduce unnecessary heparin exposure, optimizing laboratory testing for suspected HIT, and reducing unnecessary procedures in patients.

The second example was thrombotic thrombocytopenic purpura (TTP). A systems-based hematologist could optimize testing for TTP, which may reduce system-wide plasma use.

The third example was a medical director for hemostasis and thrombosis. A systems-based hematologist could foster appropriate and safe practices, including the implementation of and adherence to preventive care for thrombotic events and the optimal use of anticoagulant medications.

The fourth example was non-malignant hematology consultation in an accountable care organization (ACO) environment. The authors noted that ACOs have enabled more patients to be served by a health system, but there are fewer incentives for physicians to manage common hematology-related issues. A funded systems-based hematologist could ensure that patients have more timely access to hematology consultations.

“A systems-based hematologist position presents a unique opportunity for hematologists to design new models for care delivery and demonstrate their ability to improve clinical outcomes while maintaining or reducing costs,” Dr Abkowitz said. “Just as blood must flow throughout the body, the expertise of hematology must flow throughout the healthcare system.”

As a next step, ASH has invited its members to share practice models they have developed and examples of how they have collaborated with others to improve healthcare outcomes, reduce complications, and eliminate unnecessary spending.

Doctor and patient

Photo courtesy of CDC

The American Society of Hematology (ASH) has released a report proposing a new role for hematologists specializing in non-malignant blood disorders.

ASH partnered with the healthcare consulting firm The Lewin Group to identify emerging career opportunities for health system- and hospital-based hematologists and to provide guidance on pursuing those opportunities.

The resulting report, published in Blood, outlines a few models for a systems-based clinical hematologist.

The report’s authors noted that demand for hematology expertise remains high nationwide. However, ASH and its members are concerned that changes to academic training will hinder both the recruitment of new talent to the field and the retention of seasoned experts.

The authors said that today’s hematology trainees are unlikely to receive the same non-malignant training as many “classic” hematologists trained in prior decades. And training shortfalls are further compounded by the fact that primary care physicians do not have the expertise to manage common blood disorders, which increases referrals to hematologists.

This results in higher demand for a smaller pool of hematologists entering the field with adequate training to effectively and efficiently manage non-malignant disorders.

“Given the rapid evolution and complexity of the field, the time is appropriate to identify career pathways that attract and enable physicians to practice non-malignant hematology in a sustainable manner,” said author Janis L. Abkowitz, MD, of the University of Washington in Seattle.

She and her colleagues noted that, in response to these challenges, US hematologists are defining new paths and assuming more centralized positions in large and small healthcare systems.

These systems-based hematologists are specialty-trained physicians—employed by a hospital, medical center, or health system—who optimize individual patient care as well as the overall system of healthcare delivery for patients with blood disorders.

For example, a systems-based hematologist could work closely with surgeons to minimize perioperative bleeding and could manage care pathways for patients with chronic blood diseases.

The report offered 4 examples where the involvement of a systems-based hematologist would lead to cost-effective decision-making. These were based upon interviews with 14 early adoptors of the systems-based approach to hematology.

The first example was heparin-induced thrombocytopenia (HIT). A systems-based hematologist could implement care pathways that focus on HIT by working to reduce unnecessary heparin exposure, optimizing laboratory testing for suspected HIT, and reducing unnecessary procedures in patients.

The second example was thrombotic thrombocytopenic purpura (TTP). A systems-based hematologist could optimize testing for TTP, which may reduce system-wide plasma use.

The third example was a medical director for hemostasis and thrombosis. A systems-based hematologist could foster appropriate and safe practices, including the implementation of and adherence to preventive care for thrombotic events and the optimal use of anticoagulant medications.

The fourth example was non-malignant hematology consultation in an accountable care organization (ACO) environment. The authors noted that ACOs have enabled more patients to be served by a health system, but there are fewer incentives for physicians to manage common hematology-related issues. A funded systems-based hematologist could ensure that patients have more timely access to hematology consultations.

“A systems-based hematologist position presents a unique opportunity for hematologists to design new models for care delivery and demonstrate their ability to improve clinical outcomes while maintaining or reducing costs,” Dr Abkowitz said. “Just as blood must flow throughout the body, the expertise of hematology must flow throughout the healthcare system.”

As a next step, ASH has invited its members to share practice models they have developed and examples of how they have collaborated with others to improve healthcare outcomes, reduce complications, and eliminate unnecessary spending.

Doctor and patient

Photo courtesy of CDC

The American Society of Hematology (ASH) has released a report proposing a new role for hematologists specializing in non-malignant blood disorders.

ASH partnered with the healthcare consulting firm The Lewin Group to identify emerging career opportunities for health system- and hospital-based hematologists and to provide guidance on pursuing those opportunities.

The resulting report, published in Blood, outlines a few models for a systems-based clinical hematologist.

The report’s authors noted that demand for hematology expertise remains high nationwide. However, ASH and its members are concerned that changes to academic training will hinder both the recruitment of new talent to the field and the retention of seasoned experts.

The authors said that today’s hematology trainees are unlikely to receive the same non-malignant training as many “classic” hematologists trained in prior decades. And training shortfalls are further compounded by the fact that primary care physicians do not have the expertise to manage common blood disorders, which increases referrals to hematologists.

This results in higher demand for a smaller pool of hematologists entering the field with adequate training to effectively and efficiently manage non-malignant disorders.

“Given the rapid evolution and complexity of the field, the time is appropriate to identify career pathways that attract and enable physicians to practice non-malignant hematology in a sustainable manner,” said author Janis L. Abkowitz, MD, of the University of Washington in Seattle.

She and her colleagues noted that, in response to these challenges, US hematologists are defining new paths and assuming more centralized positions in large and small healthcare systems.

These systems-based hematologists are specialty-trained physicians—employed by a hospital, medical center, or health system—who optimize individual patient care as well as the overall system of healthcare delivery for patients with blood disorders.

For example, a systems-based hematologist could work closely with surgeons to minimize perioperative bleeding and could manage care pathways for patients with chronic blood diseases.

The report offered 4 examples where the involvement of a systems-based hematologist would lead to cost-effective decision-making. These were based upon interviews with 14 early adoptors of the systems-based approach to hematology.

The first example was heparin-induced thrombocytopenia (HIT). A systems-based hematologist could implement care pathways that focus on HIT by working to reduce unnecessary heparin exposure, optimizing laboratory testing for suspected HIT, and reducing unnecessary procedures in patients.

The second example was thrombotic thrombocytopenic purpura (TTP). A systems-based hematologist could optimize testing for TTP, which may reduce system-wide plasma use.

The third example was a medical director for hemostasis and thrombosis. A systems-based hematologist could foster appropriate and safe practices, including the implementation of and adherence to preventive care for thrombotic events and the optimal use of anticoagulant medications.

The fourth example was non-malignant hematology consultation in an accountable care organization (ACO) environment. The authors noted that ACOs have enabled more patients to be served by a health system, but there are fewer incentives for physicians to manage common hematology-related issues. A funded systems-based hematologist could ensure that patients have more timely access to hematology consultations.

“A systems-based hematologist position presents a unique opportunity for hematologists to design new models for care delivery and demonstrate their ability to improve clinical outcomes while maintaining or reducing costs,” Dr Abkowitz said. “Just as blood must flow throughout the body, the expertise of hematology must flow throughout the healthcare system.”

As a next step, ASH has invited its members to share practice models they have developed and examples of how they have collaborated with others to improve healthcare outcomes, reduce complications, and eliminate unnecessary spending.