How would you consider approaching the treatment of the following patient case?
Adrian is 77 years old and has been living alone since his wife died 12 years ago
He avidly follows sports news and often spends time angling in local rivers
Adrian was diagnosed with atrial fibrillation (AF) 5 years ago after complaining about dizziness and being short of breath; he was prescribed warfarin for protection against stroke
His kidney function was normal for his age, with an estimated glomerular filtration rate (eGFR) of 73 ml/min/1.73 m2; however, his doctor has found signs of a decline in his kidney function during routine check-ups over the last 2 years
During the Bayer sponsored symposium at the ESC congress 2021, the panel of experts explored some of the issues and treatment considerations applicable to patients with AF who have diabetes, renal dysfunction, or who are ageing.
Ken is 68 years old and has played the guitar in a band for over 15 years. Five years ago, Ken found himself having difficulty sleeping and urinating more frequently during the night. As these symptoms persisted, he began to lose his appetite and regularly found himself short of breath. After a visit to his doctor, urine and blood tests confirmed that Ken had abnormal kidney function with a creatinine clearance (CrCl) of 46 ml/min.
The band recently completed a national tour, travelling in a tour bus to more than 30 cities over 50 dates. Towards the end of the tour, Ken noticed that his right leg had become swollen and felt painful to the touch. Due to an extended period of immobility, he had developed a deep vein thrombosis (DVT).
What does the data tell us about treating patients with abnormal kidney function for acute venous thromboembolism (VTE)?
This is Gordon. Gordon is 44 years old and works as a journalist.
One year ago, just after Gordon and his wife had bought their first home, Gordon was diagnosed with lung cancer. Three months later, while he was still coming to terms with both the diagnosis and the demands of cancer treatment, Gordon developed a painful and swollen right leg. Compression ultrasound scans confirmed that Gordon had suffered a deep vein thrombosis (DVT).
For patients such as Gordon, a cancer diagnosis isn’t just associated with the burden of the malignant disease itself but also with that of cancer-associated thrombosis (CAT). Patient safety is a key consideration for physicians treating patients such as Gordon and must be balanced carefully against efficacy when making treatment choices.
What can we learn from clinical trial data in order to guide appropriate treatment choice?
Hosted from Philadelphia, USA, but run as a fully virtual event, the International Society on Thrombosis and Haemostasis (ISTH) 2021 conference took place from 17 to 21 July. Over the five days, participants were treated to a wealth of presentations and discussions, which included new data in venous thromboembolism (VTE), cancer-associated thrombosis (CAT) and peripheral artery disease (PAD).
Full recordings of presentations made at the meeting are available to registered participants and can be accessed at www.isth2021live.org. Conference abstracts are freely available at abstracts.isth.org.
Isabella had barely come to terms with her diagnosis of cancer when she was diagnosed with cancer-associated thrombosis (CAT). She is not alone in this, because patients with cancer are at higher risk of venous thromboembolism (VTE) compared with the general population, and CAT is cited as the second leading cause of death in these patients, after cancer itself.
Advancing age is an independent risk factor for AF and, consequently, many strokes in older patients are related to AF. The risk of stroke in patients with AF is raised by 45% per decade of age. Older patients who suffer a stroke will be in hospital for longer, are less likely to be discharged to their homes and are at an increased risk of death compared with younger patients.
This year marked the 10th anniversary of the annual International Conference on Thrombosis and Hemostasis Issues in Cancer (ICTHIC), with the meeting running from the 22 to 26 April. Although the conference was fully virtual, the organizers generated a remarkable digital representation of the monumental complex of Sant’Agostino in Bergamo, Italy, where the meeting takes place each year.