Catch up from the BBTS session to follow... now its thrombosis free comms and Laura Green presenting ORANGE #BSH2017
Annual major bleeding rate for pts on oral anticoagulants 1.2-3.6% in trials, almost certainly higher in real life #BSH2017
Warfarin is one of the drugs most frequently wrongly prescribed and dispensed #BSH2017
ORANGE study -multicentre, observational study of management and outcomes of pts who develop major bleeding while on oral a/c #BSH2017
Published description of the study is here onlinelibrary.wiley.com/doi/10.1111/bj… #BSH2017
2192 pts over 3 years. 80% were on warfarin, 70% were on oral a/c for AF #BSH2017
44% ICH, 32% GI bleeding. More ICH in those on warfarin, more GI bleeding in DOACs. Excess ICH bleeding due to SDH -not other types #BSH2017
Only 28% those on DOACs (&6% on warfarin) received TXA #BSH2017
Mortality rates were no different whether bleeding on warfarin or DOAC. Higher mortality w ICH vs GI bleeding #BSH2017
Pt selectn by inclusion criteria &participating hospitals may have led to more ICH than expected &contributed to more mortality #BSH2017
Dr Arachchillage next - should we abandon APTT for monitoring UFH? #BSH2017
Is there a role for anti-Xa in heparin monitoring? Royal Brompton uses this as standard #BSH2017
Poor concordance between APTT 1.5-2.5 and antiXa 0.3-0.7, especially in children (but still only ~50% in adults) #BSH2017
Discordance would lead to underanticoagulation in infants and over anticoagulation in adults #BSH2017
Next is Dr Alwan on predictive value of presenting ADAMTS13 ag & ab levels for clinical course in TTP #BSH2017
Poor prognosis in TTP assocd w lower ADAMTS13 levels, younger age, Caucasian ethnicity, severe cerebral involvement &raised trop #BSH2017
But some studies show older age also adverse risk factor #BSH2017
In UK TTP registry higher anti ADAMTS13 level correlated w GCS <15, raised troponin levels, more PEx needed, higher mortality #BSH2017
68% had raised trop at presentation. These pts 6x more likely to die #BSH2017
GCS<15 = 9x more likely to die of TTP #BSH2017
What to do in those w poor prognositic factors? increase freq or volume of PEx - not evidence based #BSH2017
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