Low-molecular-weight heparins and cancer: focus on antitumoral effect.

AbstractA close relationship between cancer and thrombosis does exist, documented by the fact that an overall 7-fold increased risk of venous thromboembolism (VTE) has been reported in patients with malignancy compared to non-malignancy. The potential impact of antithrombotic agents in cancer-associated VTE has long been recognized, and, in particular, several clinical trials in the last 20 years have reported the safety and efficacy of low-molecular-weight heparins (LMWHs) for treatment and prophylaxis of VTE in patients with various types of cancer. More recently, a number of preclinical and clinical studies have suggested that LMWHs may improve survival in cancer patients with mechanisms that are different from its antithrombotic effect but are linked to the ability of influencing directly the tumor biology. This paper reviews the evidence around the potential survival benefits of LMWHs by analyzing the suggested mechanisms and the available clinical data

Direct oral anticoagulants and venous thromboembolism

Venous thromboembolism (VTE), consisting of deep vein thrombosis and pulmonary embolism, is a major clinical concern associated with significant morbidity and mortality. The cornerstone of management of VTE is anticoagulation, and traditional anticoagulants include parenteral heparins and oral vitamin K antagonists. Recently, new oral anticoagulant drugs have been developed and licensed, including direct factor Xa inhibitors (e.g. rivaroxaban, apixaban and edoxaban) and thrombin inhibitors (e.g. dabigatran etexilate). This narrative review focusses on the characteristics of these direct anticoagulants and the main results of published clinical studies on their use in the prevention and treatment of VTE

Il fine della ricerca indipendente: Non registrativa o registrativa?

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Gene transfer in hemophilia A: not cogent yet

The phase 3 clinical study of gene transfer in hemophilia A using the BioMarin vector AAV5-hFVIII-SQ (also identified as valoctocogene roxaparvovec) recently reported the results obtained in as many as 134 adult men with severe hemophilia A, so that it is at the moment the largest gene transfer study ever conducted in a rare monogenic disorder [...]

An ecological alliance against air pollution and cardiovascular disease

This narrative review article summarizes the strong available evidence that casually links indoor and outdoor air pollution to cardiovascular disease. It also discusses as a possible approach to mitigate this ubiquitous risk factor the use in the household of ornamental potted plants, and their variable degree of effectiveness for the removal of different indoor pollutants such as volatile organic compounds (formaldehyde, benzene, toluene, xylene). Thus, the choice of the plants should be tailored to the types and concentrations of the pollutants present in each household. Outdoor air is less polluted than indoor air in terms of concentrations of the gaseous (NO2) and particulate components (PM10, PM2.5, PM0.1), but it does hamper to a higher extent health because a large fraction of the population is inevitably exposed at the time of breezing. Being cognizant of the difficulties currently encountered in the attempts to mitigate the major sources of ambient air pollution (vehicle traffic and domestic heating) a strategy based upon a massive increase of green spaces in urban areas has been shown not only to positively mitigate air pollution but also improve life expectancy, general health and resilience

The management of hemophilia in elderly patients

After the increasing rate of deaths observed during the 1980s due to human immunodeficiency virus (HIV) infection, the health-related quality of life and life expectancy of persons with hemophilia have improved, mainly due to the progresses of replacement therapy and antiviral drugs and to the improvement of the global comprehensive care provided by specialized centers. As a consequence, an increasing number of hemophiliacs have reached an older age and nowadays physicians in hemophilia centers find that they must handle age-related clinical problems never previously observed in this population. The management of elderly persons with congenital hemophilia is discussed in the first part of this review. The second part describes the general aspects of acquired hemophilia due to anti-factor VIII autoantibodies, focusing on the clinical management of elderly patients, one of the groups most frequently affected by this acquired bleeding disorder

Efficacy and safety of tranexamic acid in acute haemorrhage

Tranexamic acid is a synthetic haemostatic drug that inhibits fibrinolysis. It is effective in reducing bleeding and mortality, although to different extents in trauma, peripartum, and surgical settings. It is generally safe and inexpensive with few adverse reactions, although further studies are needed to assess its safety in settings of high thromboembolic risk

Pro-coagulant imbalance in patients with chronic liver disease

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Safety of intravenous tranexamic acid in patients undergoing major orthopaedic surgery. A meta-analysis of randomised controlled trials

Among the various pharmacological options to decrease peri-operative bleeding, tranexamic acid appears to be one of the most interesting. Several trials have consistently documented the efficacy of this synthetic drug in reducing the risk of blood loss and the need for allogeneic blood transfusion in patients undergoing total hip and knee arthroplasty. The safety of intravenous tranexamic acid in major orthopaedic surgery, particularly regarding the risk of venous thromboembolism, was systematically analysed in this review. A systematic search of the literature identified 73 randomised controlled trials involving 4,174 patients and 2,779 controls. The raw overall incidence of venous thromboembolism was 2.1% in patients who received intravenous tranexamic acid and 2.0% in controls. A meta-analytic pooling showed that the risk of venous thromboembolism in tranexamic acid-treated patients was not significantly different from that of controls (risk difference: 0.01%, 95% confidence interval [CI]: -0.05%, 0.07%; risk ratio: 1.067, 95% CI: 0.760-1.496). Other severe drug-related adverse events occurred very rarely (0.1%). In conclusion, the results of this systematic review and meta-analysis show that intravenous tranexamic acid is a safe pharmacological treatment to reduce blood loss and transfusion requirements in patients undergoing major orthopaedic surgery