Introduced by Associate Editor Thomas Ortel, this Review Series focuses on factor XI (FXI). The series opens with a review of the biology of FXI, proceeds to a discussion of congenital FXI ...deficiency, and concludes with a discussion of the use of therapies targeting FXI and factor XIa as active anticoagulants with a decreased risk of bleeding complications.
Edited by Associate Editor Thomas Ortel, this How I Treat series on hematologic complications of pregnancy uses illustrative cases to discuss the management of thrombocytopenia, antiphospholipid ...syndrome, sickle cell disease, and myeloid proliferative neoplasms in the setting of pregnancy.
Edited by Associate Editor Thomas L. Ortel, this How I Treat series focuses on geriatric hematology. Using illustrative cases, the authors present their approach to geriatric patients with von ...Willebrand disorders, anemia, thrombocytopenia, and multiple myeloma.
The development of vaccines to fight COVID-19 has been a remarkable medical achievement. However, this global immunization effort has been complicated by a rare vaccine-related outcome characterized ...by thrombocytopenia and thrombosis in association with platelet-activating anti–platelet factor 4 antibodies. In this Spotlight, we will discuss the recently described complication of vaccine-induced immune thrombotic thrombocytopenia (VITT) occurring in response to certain COVID-19 vaccines. Although information about this clinical condition is rapidly evolving, we will summarize our current understanding of VITT.
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Perioperative management of antithrombotic therapy is a situation that occurs frequently and requires consideration of the patient, the procedure, and an expanding array of anticoagulant and ...antiplatelet agents. Preoperative assessment must address each patient's risk for thromboembolic events balanced against the risk for perioperative bleeding. Procedures can be separated into those with a low bleeding risk, which generally do not require complete reversal of the antithrombotic therapy, and those associated with an intermediate or high bleeding risk. For patients who are receiving warfarin who need interruption of the anticoagulant, consideration must be given to whether simply withholding the anticoagulant is the optimal approach or whether a perioperative “bridge” with an alternative agent, typically a low-molecular-weight heparin, should be used. The new oral anticoagulants dabigatran and rivaroxaban have shorter effective half-lives, but they introduce other concerns for perioperative management, including prolonged drug effect in patients with renal insufficiency, limited experience with clinical laboratory testing to confirm lack of residual anticoagulant effect, and lack of a reversal agent. Antiplatelet agents must also be considered in the perioperative setting, with particular consideration given to the potential risk for thrombotic complications in patients with coronary artery stents who have antiplatelet therapy withheld.
Since the COVID-19 pandemic began over 2 years ago, its global impact has been enormous. Our growing understanding of the pathophysiology of this disease has particular links to hematology. ...Introduced by Ortel and Berliner, this Review Series provides up-to-date overviews of the many areas in which COVID-19 has implications for hematology practice.
In this Review Series, introduced by Associate Editor Thomas L. Ortel, experts contribute 6 seminal reviews that focus on the treatment of venous thromboembolism (VTE) in adults and children, the ...management of VTE developing in unusual locations and in the setting of thrombophilia, and new targets and antithrombotic therapies in development.
Commissioned and introduced by Associate Editors Irene Roberts and Thomas Ortel, this Review Series focuses on common areas in pediatric hematology practice, emphasizing new therapeutic and ...diagnostic developments. The specific challenges of managing hemostatic and thrombotic disorders in children are described by O’Brien and Zia. Distinguishing acquired immune diseases from inherited disorders of blood counts is a common problem for pediatric hematologists, and this is tackled in reviews by Grace and Lambert for thrombocytopenias and by Dokal et al for bone marrow failure. Finally, Gallagher provides a stepwise approach to the diagnosis and treatment of anemia in infancy and childhood, at both the individual patient level and the population level.
In August 2022, these guidelines were reviewed by an expert work group convened by ASH. Review included limited searches for new evidence and discussion of the search results. Following this review, ...the ASH Committee on Quality agreed to continue monitoring the supporting evidence rather than revise or retire these guidelines at this time. Limited searches and expert review will be repeated annually going forward until these guidelines are revised or retired.
Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), occurs in ∼1 to 2 individuals per 1000 each year, corresponding to ∼300 000 to 600 000 events in the United States annually.
Objective: These evidence-based guidelines from the American Society of Hematology (ASH) intend to support patients, clinicians, and others in decisions about treatment of VTE.
Methods: ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and adult patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment.
Results: The panel agreed on 28 recommendations for the initial management of VTE, primary treatment, secondary prevention, and treatment of recurrent VTE events.
Conclusions: Strong recommendations include the use of thrombolytic therapy for patients with PE and hemodynamic compromise, use of an international normalized ratio (INR) range of 2.0 to 3.0 over a lower INR range for patients with VTE who use a vitamin K antagonist (VKA) for secondary prevention, and use of indefinite anticoagulation for patients with recurrent unprovoked VTE. Conditional recommendations include the preference for home treatment over hospital-based treatment for uncomplicated DVT and PE at low risk for complications and a preference for direct oral anticoagulants over VKA for primary treatment of VTE.
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