1b) Our expert co-faculty are Tzu-Fei Wang MD @TzufeiWang, #thrombosis & benign #shematologist
— cardio-met (@cardiomet_CE) October 4, 2023
from @OttawaHospital and Alok Khorana MD @aakonc, Hardis Endowed Chair, Prof Med, Vice Chair Taussig Cancer Inst, Dir GI Cancers, @ClevelandClinic pic.twitter.com/xj00EwinEw
3) Let's start with the basics. Patients with #cancer have a 12X increased risk of VTE compared to those without cancer, with the risk further increased to 23X with #anticancer therapy.
— cardio-met (@cardiomet_CE) October 4, 2023
🔓 https://t.co/jxTOdw1jmP pic.twitter.com/6Rb3hGyQh3
5) In 2003, #CLOT was the first pivotal #RCT in #CAT to show that #LMWH is superior to #VKA in preventing recurrent VTE without an increased risk of bleeding 🩸.
— cardio-met (@cardiomet_CE) October 4, 2023
🔓 https://t.co/0YCqsLc3pf pic.twitter.com/gQaZtUXA0o
6b) https://t.co/Ia6yw4qC4r
— cardio-met (@cardiomet_CE) October 4, 2023
Safety: pic.twitter.com/gMz8BGQ76C
8)
— cardio-met (@cardiomet_CE) October 4, 2023
👉#Select_D trial (N=406) https://t.co/owrdj9MCmI
👉#CASTA_DIVA trial (N=158) https://t.co/mtTYLRxMqw
These compared #rivaroxaban to #dalteparin. Rivaroxaban was associated with an increased risk of #CRNMB in Select-D. pic.twitter.com/N96yoFX6Da
10) Same comparison, similar results in #ADAM_VTE trial (N=300)
— cardio-met (@cardiomet_CE) October 4, 2023
🔓 https://t.co/mWetCdYH9M pic.twitter.com/oGz1B0lBjx
12a) So where are we?
— cardio-met (@cardiomet_CE) October 4, 2023
👉Major international guidelines rec DOACs or LMWH as anticoagulants of choice for CAT.
👉DOACs might be preferred except for pts at ⬆️risk of 🩸(such as unresected luminal GI and GU #cancer) or with clinically important drug-drug interactions #DDIs. pic.twitter.com/RprnBawSkJ
12c) MORE references:
— cardio-met (@cardiomet_CE) October 4, 2023
✔️ @escardio: https://t.co/ZtJrUUTeaz
✔️@ACCP: https://t.co/QZAjyGAAtF
✔️@myESMO: https://t.co/8ryehv2ANG
✔️@ESVSmembership: https://t.co/gWIAenjXEu pic.twitter.com/QMVkhzXIXg
14a) #EVE #RCT (NCT03080883) results reported at 2023 @ISTH by @RobMcbane.
— cardio-met (@cardiomet_CE) October 4, 2023
N=360, #apixaban 2.5mg BID ➡️ ❓similar risk of 🩸& recurrent #VTE vs 5mg BID
Can we safely reduce the dose of DOAC in patients with #CAT after an initial 6-12 month tx period? pic.twitter.com/vzlHWw2axb
15a) The home run here for #DOACs could be a bigger version of #EVE, called #API_CAT (NCT03692065).
— cardio-met (@cardiomet_CE) October 4, 2023
(N=1767) addressing this issue results are anticipated soon! See @isabellemahe1 🇫🇷 at al for methodology and rationale at https://t.co/Ieagz9pFrZ
15c) Eligible pts will have active #cancer & have completed ≥6 months of anticoagulant therapy for a documented index event of proximal #DVT and/or #PE.
— cardio-met (@cardiomet_CE) October 4, 2023
16b) Some DOACs (edoxaban + rivaroxaban) may ⬆️ risk of major 🩸 (GI #cancer). #DDIs with #chemotherapy are common due to metabolism through CYP3A4 and P-gp. #Liver and renal 🫘dysfunction are common in patients with #cancer and can lead to DOAC bioaccumulation.
— cardio-met (@cardiomet_CE) October 4, 2023
17b) Learn more about this and earn even MORE 🆓CE/#CME from @MarcCarrier1 & @aakonc in their #tweetorialat https://t.co/yeXaVE4weS. pic.twitter.com/urnGQ6leSj
— cardio-met (@cardiomet_CE) October 4, 2023
18b) #Abelacimabis the only #FXI inhibitor currently being investigated for the management of #CAT and is only one that dually inhibits FXI and FXIa.
— cardio-met (@cardiomet_CE) October 4, 2023
20) Could FXI inhibition address unmet needs in management of #CAT?
— cardio-met (@cardiomet_CE) October 4, 2023
1) Lower bleeding potential
2) Monthly dosing = better persistence
3) No DDIs
4) Not renally eliminated, not metabolized by #liver
22) Why two RCTs? As you saw in the #guidelines discussion above, for some pts with #CAT, #LMWH is the standard & for others #DOACs are the standard. The 2 concurrent RCTs address both these populations with different control arms.
— cardio-met (@cardiomet_CE) October 4, 2023
24a) So let's wrap this up. What have you learned? What do #guidelines suggest for proximal lower extremity 🦵#CAT in pts with active #intraluminal GI #cancer?
— cardio-met (@cardiomet_CE) October 4, 2023
24c) It's a. We can add #liver dysfunction & better persistence on #anticoagulation. Factor XI inhibitors may provide a potential novel approach to address current unmet needs and on-going trials (#ASTER and #MAGNOLIA) may help to optimize management of #CAT.
— cardio-met (@cardiomet_CE) October 4, 2023
25) You just earned 0.5hr 🆓CE/#CME! Grab your certificate for credit at https://t.co/NvstbRPMvP, and follow us here on @cardiomet_ce for more education on this & other topics related to #thrombosis! @TzufeiWang & @aakonc thank you for joining us!
— cardio-met (@cardiomet_CE) October 4, 2023