2a) The program is intended for #healthcare professionals & supported by an independent educational grant from Anthos Therapeutics. Statement of accreditation & faculty disclosures at https://t.co/gvXca4G9Xm.
— cardio-met (@cardiomet_CE) January 9, 2024
3) The problem #CAT = #cancer-associated #thrombosis is that pts w/cancer have an ⬆️risk of thrombosis
— cardio-met (@cardiomet_CE) January 9, 2024
🚨20%-30% of all #VTE occur in pts with cancer
🚑 #CAT is associated w/⬆️morbidity & mortality
Great schematic here from fellow faculty @aakonc , https://t.co/CL1g7zXQOE pic.twitter.com/L5PkUZTzjt
5) Evidence ➡️cancer itself is associated with a state of #hypercoagulability, driven by release of #procoagulant factors e.g. tissue factor #TF, from malignant tissue, & by inflammation-driven activation of endothelial cells, #platelets, & #leukocyteshttps://t.co/JILJlVIzHS pic.twitter.com/1hJ4jQ9Ke2
— cardio-met (@cardiomet_CE) January 9, 2024
7) Per 🔓 https://t.co/vR6Jnoqs2M, the risk of #VTE varies over the natural history of #cancer, with the highest risk occurring during hospitalization and following the development of #metastatic disease. pic.twitter.com/2EgKSlRl5S
— cardio-met (@cardiomet_CE) January 9, 2024
9) To that point, #LMWH was the 🪙 standard tx of acute #CAT for 15 years, based on #CLOT trial: ⬇️ #VTE recurrence w/ #dalteparin compared to #VKA.
— cardio-met (@cardiomet_CE) January 9, 2024
Since then, dalteparin (w/ dose ⬇️ to 75% after 1 mo) has become the comparator for all major studies
🔓 https://t.co/0YCqsLc3pf pic.twitter.com/Oz7wUCsu7C
11) These were followed by #CANVAS, a #pragmatic #effectiveness trial of pts w/ #CAT randomized to #DOAC vs "SOC."
— cardio-met (@cardiomet_CE) January 9, 2024
Results:
1⃣ DOAC noninferior for preventing recurrent VTE
2⃣ No diff in major 🩸 (58.5% of DOAC was #apixaban)
3⃣ better adherence with DOAChttps://t.co/t19C7yES53 pic.twitter.com/bk9cofhwti
13a) In #cancer, tho, one size rarely fits all. #Gastrointestinal #GI tumors are a problem! In #SELECT_D (riva vs dalt) the #DSMB advised enrolling no more upper GI malignancies. In #HOKUSAI, major 🩸on edox were GI in 22/32 cases, vs 5/16 GI with dalteparin.
— cardio-met (@cardiomet_CE) January 9, 2024
14) So how do we currently treat acute #CAT? There are many considerations: pic.twitter.com/D5j5cdWOMJ
— cardio-met (@cardiomet_CE) January 9, 2024
16) Recurrent #VTE in #cancer: pic.twitter.com/5a3s0mycgR
— cardio-met (@cardiomet_CE) January 9, 2024
17b) See how we practice at🔓 https://t.co/8kSNE8kror: pic.twitter.com/BuB8Wzqxg2
— cardio-met (@cardiomet_CE) January 9, 2024
19a) How long to treat?
— cardio-met (@cardiomet_CE) January 9, 2024
Most #RCT for #CAT 🛑at 6mos ➡️ guidelines advise only on tx first 6mos after acute VTE
👉 #DALTECAN: Ph 4 prospective single arm safety trial of dalteparin over 12mos ➡️low rate major bleeding🩸
(cont)
19c) Current consensus–beyond guidelines–is to continue therapeutic dose anticoagulation in the setting of persistent #cancer or continued cancer treatments pic.twitter.com/zs5t0zqvOP
— cardio-met (@cardiomet_CE) January 9, 2024
20b) (cont)
— cardio-met (@cardiomet_CE) January 9, 2024
👉 2 RCTs testing apixaban 2.5bid vs apixaban 5bid for 12 months after 6 months of therapeutic dose anticoagulation for acute VTE:
21a) What dos the future🔮 hold? Perhaps it's specific #FXI / #FXIa inhibition. Limited data so far, but studies underway!
— cardio-met (@cardiomet_CE) January 9, 2024
Rationale 1⃣ : #Anticoagulants significantly ⬇️ risk of #thromboembolic events & are excellent tx for acute #VTE but bring ⬆️ 🩸risk, esp in pts w/ #cancer
21c) Ph 2 data with #abelacimab, a monoclonal antibody to #FXI and FXIa, demonstrate efficacy in the TKR population with no safety signals
— cardio-met (@cardiomet_CE) January 9, 2024
🔓https://t.co/YB265c1agJ
22b) 2⃣ RCTs are assessing the efficacy and safety of #abelacimab for the management of #CAT.
— cardio-met (@cardiomet_CE) January 9, 2024
🌼#ASTER (NCT 05171049): Abelacimab vs. apixaban
💮#MAGNOLIA (NCT 05171075): Abelacimab vs. #LMWH (dalteparin) in patients w/ GI & GU tumors pic.twitter.com/eM7GxKWnCI
23a) So let's wrap this up. For which #CAT group is 🩸risk on #anticoagulation particularly increased?
— cardio-met (@cardiomet_CE) January 9, 2024
a. #leukemia
b. #lungcancer
c. #GI cancer
d. #PancreaticCancer
24a) Specific inhibition of #FXI in the coagulation cascade results in
— cardio-met (@cardiomet_CE) January 9, 2024
a. interference with #hemostasis
b. interference with #thrombosis
c. less #thrombin generation
d. less stable clots
for 24a)
— cardio-met (@cardiomet_CE) January 9, 2024
25a) One final note. Many of you may have heard about the premature termination of the #OCEANIC_AF trial. That was a trial of the small-molecule #FXIa inhibitor #asundexian against #apixaban for stroke prevention in #AFib.
— cardio-met (@cardiomet_CE) January 9, 2024
25c) In light of the #OCEANIC_AF findings, the #DMC for #ASTER reviewed enrollments to date and did not recommend any changes to the #ASTER protocol.
— cardio-met (@cardiomet_CE) January 9, 2024
26) Thanks for joining us! You just earned 0.5hr 🆓CE/#CME, & you can claim your certificate NOW at https://t.co/Rs2rLU4YR6. And join expert faculty @connors_md in FOLLOWING @cardiomet_ce for the best #MedEd available wholly by #tweetorial!
— cardio-met (@cardiomet_CE) January 9, 2024