HT Staff

Hemoglobin concentrations in the high normal range in patients with anemia due to chronic kidney disease result in an excess risk of major adverse events, reported Arintaya Phrommintikul, MD, and colleagues from Monash University, Melbourne, Australia.

Adverse events include death, arteriovenous access thrombosis, and poorly controlled hypertension.

The investigators conducted a meta-analysis of 9 randomized controlled studies that enrolled 5143 patients treated with recombinant human erythropoietin.

Patients in the group targeted for a higher hemoglobin level (120-160 g/L) had a higher risk for all-cause mortality than patients in the lower hemoglobin target group (< 120 g/L) (risk ratio 1.17, P = 0.031).

There was also a higher risk for arteriovenous access thrombosis (risk ratio 1.34, P=0.0001) as well as a significantly higher risk of poorly controlled blood pressure (risk ratio 1.27, P=0.004) in the higher hemoglobin target group. The incidence of myocardial infarction was similar in the two groups.

Current guidelines recommend the maintenance of hemoglobin concentrations at 110 g/L or higher, based mainly on evidence of benefit in quality-of-life measures.

Current guidelines do not include an upper limit for the target hemoglobin concentration. The authors suggest that an upper limit should be added in future revisions of guideline recommendations.

The study was published in the 3 February 2007 issue of Lancet. 

Hemoglobin concentrations in the high normal range in patients with anemia due to chronic kidney disease result in an excess risk of major adverse events, reported Arintaya Phrommintikul, MD, and colleagues from Monash University, Melbourne, Australia.

Adverse events include death, arteriovenous access thrombosis, and poorly controlled hypertension.

The investigators conducted a meta-analysis of 9 randomized controlled studies that enrolled 5143 patients treated with recombinant human erythropoietin.

Patients in the group targeted for a higher hemoglobin level (120-160 g/L) had a higher risk for all-cause mortality than patients in the lower hemoglobin target group (< 120 g/L) (risk ratio 1.17, P = 0.031).

There was also a higher risk for arteriovenous access thrombosis (risk ratio 1.34, P=0.0001) as well as a significantly higher risk of poorly controlled blood pressure (risk ratio 1.27, P=0.004) in the higher hemoglobin target group. The incidence of myocardial infarction was similar in the two groups.

Current guidelines recommend the maintenance of hemoglobin concentrations at 110 g/L or higher, based mainly on evidence of benefit in quality-of-life measures.

Current guidelines do not include an upper limit for the target hemoglobin concentration. The authors suggest that an upper limit should be added in future revisions of guideline recommendations.

The study was published in the 3 February 2007 issue of Lancet. 

Hemoglobin concentrations in the high normal range in patients with anemia due to chronic kidney disease result in an excess risk of major adverse events, reported Arintaya Phrommintikul, MD, and colleagues from Monash University, Melbourne, Australia.

Adverse events include death, arteriovenous access thrombosis, and poorly controlled hypertension.

The investigators conducted a meta-analysis of 9 randomized controlled studies that enrolled 5143 patients treated with recombinant human erythropoietin.

Patients in the group targeted for a higher hemoglobin level (120-160 g/L) had a higher risk for all-cause mortality than patients in the lower hemoglobin target group (< 120 g/L) (risk ratio 1.17, P = 0.031).

There was also a higher risk for arteriovenous access thrombosis (risk ratio 1.34, P=0.0001) as well as a significantly higher risk of poorly controlled blood pressure (risk ratio 1.27, P=0.004) in the higher hemoglobin target group. The incidence of myocardial infarction was similar in the two groups.

Current guidelines recommend the maintenance of hemoglobin concentrations at 110 g/L or higher, based mainly on evidence of benefit in quality-of-life measures.

Current guidelines do not include an upper limit for the target hemoglobin concentration. The authors suggest that an upper limit should be added in future revisions of guideline recommendations.

The study was published in the 3 February 2007 issue of Lancet. 

ORLANDO—A new oral anticoagulant in development, dabigatran etexilate, was shown to be as effective and safe as the low-molecular-weight enoxaparin in prophylaxis of thromboembolism in patients undergoing total knee replacement surgery.

Bengt I. Eriksson, MD, reported these results on behalf of the RE-MODEL study group during the 2006 annual meeting of the American Society of Hematology in December.

The RE-MODEL study was a large multicenter study conducted in 2010 patients undergoing elective total knee surgery in Europe, South Africa, and Australia.

Patients were randomized to receive subcutaneous injections of enoxaparin (40 mg, once daily) or to one of 2 doses of oral dabigatran etexilate (150 mg or 220 mg once daily) for 8 ± 2 days. Enoxaparin was administered 12 hours prior to surgery while dabigatran was administered 1-4 hours after the surgery.

Dabigatran etexilate met the prespecified primary endpoint of noninferiority versus enoxaparin. There was no difference in the incidence of total venous thromboembolism and all-cause mortality between the dabigatran 220 mg and 150 mg treatment arms and enoxaparin (36%, 41%, 38%, respectively).

The secondary efficacy endpoint, the incidence of proximal deep vein thrombosis and/or pulmonary embolism was similar in all treatment arms: 4%, 3%, and 4% of patients receiving dabigatran 220 mg, dabigatran 150 mg, and enoxaparin, respectively.

There was no difference among all treatment arms in bleeding rates (either major or any bleedings), and there were no signs of liver toxicity in the dabigatran arm.

Patients undergoing knee replacement surgery are at an increased risk of developing thromboembolism. Dabigatran etexilate is an oral direct thrombin inhibitor, and offers a convenient fixed oral dosing with no need for coagulation monitoring. 

ORLANDO—A new oral anticoagulant in development, dabigatran etexilate, was shown to be as effective and safe as the low-molecular-weight enoxaparin in prophylaxis of thromboembolism in patients undergoing total knee replacement surgery.

Bengt I. Eriksson, MD, reported these results on behalf of the RE-MODEL study group during the 2006 annual meeting of the American Society of Hematology in December.

The RE-MODEL study was a large multicenter study conducted in 2010 patients undergoing elective total knee surgery in Europe, South Africa, and Australia.

Patients were randomized to receive subcutaneous injections of enoxaparin (40 mg, once daily) or to one of 2 doses of oral dabigatran etexilate (150 mg or 220 mg once daily) for 8 ± 2 days. Enoxaparin was administered 12 hours prior to surgery while dabigatran was administered 1-4 hours after the surgery.

Dabigatran etexilate met the prespecified primary endpoint of noninferiority versus enoxaparin. There was no difference in the incidence of total venous thromboembolism and all-cause mortality between the dabigatran 220 mg and 150 mg treatment arms and enoxaparin (36%, 41%, 38%, respectively).

The secondary efficacy endpoint, the incidence of proximal deep vein thrombosis and/or pulmonary embolism was similar in all treatment arms: 4%, 3%, and 4% of patients receiving dabigatran 220 mg, dabigatran 150 mg, and enoxaparin, respectively.

There was no difference among all treatment arms in bleeding rates (either major or any bleedings), and there were no signs of liver toxicity in the dabigatran arm.

Patients undergoing knee replacement surgery are at an increased risk of developing thromboembolism. Dabigatran etexilate is an oral direct thrombin inhibitor, and offers a convenient fixed oral dosing with no need for coagulation monitoring. 

ORLANDO—A new oral anticoagulant in development, dabigatran etexilate, was shown to be as effective and safe as the low-molecular-weight enoxaparin in prophylaxis of thromboembolism in patients undergoing total knee replacement surgery.

Bengt I. Eriksson, MD, reported these results on behalf of the RE-MODEL study group during the 2006 annual meeting of the American Society of Hematology in December.

The RE-MODEL study was a large multicenter study conducted in 2010 patients undergoing elective total knee surgery in Europe, South Africa, and Australia.

Patients were randomized to receive subcutaneous injections of enoxaparin (40 mg, once daily) or to one of 2 doses of oral dabigatran etexilate (150 mg or 220 mg once daily) for 8 ± 2 days. Enoxaparin was administered 12 hours prior to surgery while dabigatran was administered 1-4 hours after the surgery.

Dabigatran etexilate met the prespecified primary endpoint of noninferiority versus enoxaparin. There was no difference in the incidence of total venous thromboembolism and all-cause mortality between the dabigatran 220 mg and 150 mg treatment arms and enoxaparin (36%, 41%, 38%, respectively).

The secondary efficacy endpoint, the incidence of proximal deep vein thrombosis and/or pulmonary embolism was similar in all treatment arms: 4%, 3%, and 4% of patients receiving dabigatran 220 mg, dabigatran 150 mg, and enoxaparin, respectively.

There was no difference among all treatment arms in bleeding rates (either major or any bleedings), and there were no signs of liver toxicity in the dabigatran arm.

Patients undergoing knee replacement surgery are at an increased risk of developing thromboembolism. Dabigatran etexilate is an oral direct thrombin inhibitor, and offers a convenient fixed oral dosing with no need for coagulation monitoring.