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Brenner B, Hull R, Arya R, Beyer-Westendorf J, Douketis J, Elalamy I, Imberti D, Zhai Z. Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in high-risk patient groups: cancer and critically ill. Thromb J 2019; 17:6. [PMID: 31011294 PMCID: PMC6466798 DOI: 10.1186/s12959-019-0196-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/02/2019] [Indexed: 12/15/2022] Open
Abstract
Background Clinical practice shows that venous thromboembolism (VTE) presents a substantial burden in medical patients, and awareness and advocacy for its primary and secondary prevention remains inadequate. Specific patient populations, such as those with cancer and the critically ill, show elevated risk for VTE, bleeding or both, and significant gaps in VTE prophylaxis and treatment exist in these groups. Objective To present novel insights and consolidated evidence collected from experts, clinical practice guidelines and original studies on the unmet needs in thromboprophylaxis, and on the treatment of VTE in two high-risk patient groups: patients with cancer and the critically ill. Methodology To identify specific unmet needs in the management of VTE, a methodology was designed and implemented that assessed gaps in prophylaxis and treatment of VTE through interviews with 44 experts in the field of thrombosis and haemostasis, and through a review of current guidelines and seminal studies to substantiate the insights provided by the experts. The research findings were then analysed, discussed and consolidated by a multidisciplinary group of experts. Results The gap analysis methodology identified shortcomings in the VTE risk assessment tools, patient stratification approaches for prophylaxis, and the suboptimal use of anticoagulants for primary prophylaxis and treatment. Conclusions Specifically, patients with cancer need better VTE risk assessment tools to tailor primary thromboprophylaxis to tumour types and disease stages, and the potential for drug–drug interactions needs to be considered. In critically ill patients, unfractionated heparin is not advised as a first-line treatment option, and the strength of evidence is increasing for direct oral anticoagulants as a treatment option over low-molecular-weight heparins. Electronic supplementary material The online version of this article (10.1186/s12959-019-0196-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Benjamin Brenner
- 1Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Russell Hull
- 2Foothills Medical Centre and Thrombosis Research Unit, University of Calgary, Calgary, Canada
| | - Roopen Arya
- 3King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Jan Beyer-Westendorf
- 3King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.,4Thrombosis Research Unit, Department of Medicine I, Division Hematology, University Hospital 'Carl Gustav Carus' Dresden, Dresden, Germany
| | - James Douketis
- 5Department of Medicine, McMaster University, Hamilton, Ontario Canada.,6Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario Canada
| | - Ismail Elalamy
- 7Hematology and Thrombosis Center, Tenon University Hospital, Sorbonne University, Paris, France
| | - Davide Imberti
- 8Haemostasis and Thrombosis Center, Hospital of Piacenza, Piacenza, Italy
| | - Zhenguo Zhai
- 9Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
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10
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Flick AC, Leverett CA, Ding HX, McInturff E, Fink SJ, Helal CJ, O’Donnell CJ. Synthetic Approaches to the New Drugs Approved During 2017. J Med Chem 2019; 62:7340-7382. [DOI: 10.1021/acs.jmedchem.9b00196] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Andrew C. Flick
- Seattle Genetics, Inc. 21823 30th Drive SE, Bothell, Washington 98021, United States
| | - Carolyn A. Leverett
- Groton Laboratories, Pfizer Worldwide Research and Development, 445 Eastern Point Road, Groton, Connecticut 06340, United States
| | - Hong X. Ding
- Pharmacodia (Beijing) Co., Ltd., Beijing, 100085, China
| | - Emma McInturff
- Groton Laboratories, Pfizer Worldwide Research and Development, 445 Eastern Point Road, Groton, Connecticut 06340, United States
| | - Sarah J. Fink
- BioDuro, 11011 Torreyana Road, San Diego, California 92121, United States
| | - Christopher J. Helal
- Groton Laboratories, Pfizer Worldwide Research and Development, 445 Eastern Point Road, Groton, Connecticut 06340, United States
| | - Christopher J. O’Donnell
- Groton Laboratories, Pfizer Worldwide Research and Development, 445 Eastern Point Road, Groton, Connecticut 06340, United States
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Nafee T, Gibson CM, Yee MK, Alkhalfan F, Chi G, Travis R, Mir M, Kalayci A, Jafarizade M, Ganti A, Kazmi SH, Ghaffarpasand E, Pitliya A, Datta S, Sharfaei S, Alihashemi M, Elsaiey A, Qamar I, Jahansouz M, Talib U, Kahe F, Habibi S, Abdelwahed M, Tariq F, Kaur M, Younes A, Walia SS, Singh A, Dildar SM, Afzal MK, Kerneis M. Betrixaban for first-line venous thromboembolism prevention in acute medically ill patients with risk factors for venous thromboembolism. Expert Rev Cardiovasc Ther 2018; 16:845-855. [PMID: 30296387 DOI: 10.1080/14779072.2018.1534068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Compared to other direct oral anticoagulants, betrixaban has a longer half-life, smaller peak-trough variance, minimal renal clearance, and minimal hepatic Cytochrome P (CYP) metabolism. The Acute Medically Ill VTE Prevention with Extended Duration Betrixaban (APEX) trial evaluated the efficacy and safety of extended duration betrixaban compared to standard duration enoxaparin in acutely ill hospitalized patients. Areas covered: This article describes the role of betrixaban in the prevention of venous thromboembolism (VTE) in acutely ill medical patients. This article provides a consolidated summary of the primary APEX study findings as well as prespecified and exploratory substudies. This article also provides a review of the results of studies in which other direct factor Xa inhibitors have been evaluated in an extended duration regimen in this patient population. Expert commentary: While previous agents have demonstrated that extended duration VTE prophylaxis can be efficacious, betrixaban is the first agent to demonstrate efficacy without an increase in major bleeding. The totality of the data from the APEX trial supports extended duration betrixaban for VTE prophylaxis in the acute medically ill patient population. As such, betrixaban has been approved in the USA for extended VTE prophylaxis in at-risk acute medically ill patients.
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Affiliation(s)
- Tarek Nafee
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - C Michael Gibson
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Megan K Yee
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Fahad Alkhalfan
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Gerald Chi
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Ryan Travis
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Mahshid Mir
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Arzu Kalayci
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Mehrian Jafarizade
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Aditya Ganti
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Syed Hassan Kazmi
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Eiman Ghaffarpasand
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Anmol Pitliya
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Sudarshana Datta
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Sadaf Sharfaei
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Mahda Alihashemi
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Ahmed Elsaiey
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Iqra Qamar
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Mohamadmostafa Jahansouz
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Usama Talib
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Farima Kahe
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Shaghayegh Habibi
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Mohammed Abdelwahed
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Feham Tariq
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Manpreet Kaur
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Ahmed Younes
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Sargun S Walia
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Amandeep Singh
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Syed Muhammad Dildar
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - M Khurram Afzal
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Mathieu Kerneis
- a PERFUSE Study Group, Cardiovascular Division, Departments of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
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