Fostamatinib effectiveness and safety for immune thrombocytopenia in clinical practice.

Fostamatinib, a recently approved syk inhibitor used in adult primary immune thrombocytopenia (ITP), has been shown to be safe and effective in this disorder. However, clinical trial results may not be similarly reproduced in clinical practice. Here 138 ITP patients (both primary and secondary) from 42 Spanish centers who had been treated with fostamatinib were evaluated prospectively and retrospectively. The median age of our cohort (55.8% women) was 66 years (interquartile range, IQR, 56-80 years). The median time since ITP diagnosis at fostamatinib initiation was 51 months (IQR, 10-166 months). The median number of therapies prior to fostamatinib initiation was 4 (IQR, 2-5), including eltrombopag (76.1%), romiplostim (57.2%) and intravenous immunoglobulins (IVIG) (44.2%). Fifty-eight patients (42.0%) had signs/symptoms of bleeding in the month prior to treatment initiation. 79.0% of patients responded to fostamatinib with 53.6% complete responses (platelet count > 100 x 109 /L). Eighty-three patients (60.1%) received fostamatinib monotherapy achieving a high response rate (85.4%). The proportion of time in response during the 27-month period examined was 83.3%. The median time to platelet response was 11 days (IQR, 7-21 days). Sixty-seven patients (48.5%) experienced adverse events, mainly grade 1-2, the commonest of which were diarrhea (n = 28) and hypertension (n = 21). One patient had deep venous thrombosis and one patient developed acute myocardial infarction. Fostamatinib was shown to be effective with good safety profile in patients with primary and secondary ITP across a wide age spectrum in this real-world study.

[Comparison of quality and hemorragic risk of oral anticoagulant therapy using acenocoumarol versus warfarin]. / Comparación de la calidad y el riesgo hemorrágico del tratamiento anticoagulante oral con acenocumarol frente a warfarina.

BACKGROUND AND OBJECTIVE: Long half life oral anticoagulants have shown a higher anticoagulation stability and a lower hemorragic risk than those of a short half life. We have compared therapeutic stability and hemorragic risk of acenocoumarol versus warfarin in 2 groups of patients on preventive anticoagulation because of atrial fibrilation (international normalised ratio [INR]: 2-3). PATIENTS AND METHOD: Data on 120 patients treated with acenocoumarol and 120 on warfarin treatment who had started and continued treatment in our hospital for a minimum of a year was collected. RESULTS: The percentage of visits within the intended range of INR (2 to 3) was 65.5% with warfarin and 63.4% with acenocoumarol. Thirty percent of patients on warfarin had 75% or more of their controls within range, while for those treated with acenocoumarol this percentage was 22.5%. In the acenocoumarol group, 0.3 visits/patient/year presented an INR > or = 6 versus 0.07 in the warfarin group (p = 0.003). CONCLUSIONS: Patients treated with acenocoumarol show a higher risk of presenting with an INR > or = 6, but no statistically significant differences are observed in therapeutic stability.

Comparación de la calidad y el riesgo hemorrágico del tratamiento anticoagulante oral con acenocumarol frente a warfarina / Comparison of quality and hemorragic risk of oral anticoagulant therapy using acenocoumarol versus warfarin

Fundamento y objetivo: Los anticoagulantes orales de vida media larga han mostrado mayor estabilidad en la anticoagulación y menor riesgo hemorrágico que los de vida media corta. En el presente estudio se ha comparado la estabilidad terapéutica y el riesgo hemorrágico del acenocumarol con la warfarina en 2 grupos de pacientes cuya indicación para la anticoagulación oral fue la fibrilación auricular (cociente internacional normalizado [INR]: 2-3). Pacientes y método: Se han recogido los datos de 120 pacientes tratados con acenocumarol y 120 tratados con warfarina que habían iniciado y proseguido el tratamiento en nuestro hospital durante un mínimo de un año. Resultados: El porcentaje de visitas con INR en intervalo terapéutico en el período de un año fue del 65,5% con la warfarina y del 63,4% con el acenocumarol. El 30% de los pacientes con warfarina tenía en el 75% o más de sus visitas el INR en intervalo terapéutico, frente al 22,5% de los tratados con acenocumarol. En el grupo del acenocumarol, 0,3 visitas/paciente/año presentaba un INR de 6 o superior, frente a 0,07 en el grupo de la warfarina (p=0,003). Conclusiones: Los pacientes tratados con acenocumarol tienen un mayor riesgo de alcanzar INR de 6 o superior. No se aprecian diferencias estadísticamente significativas en la estabilidad terapéutica

Background and objective: Long half life oral anticoagulants have shown a higher anticoagulation stability and a lower hemorragic risk than those of a short half life. We have compared therapeutic stability and hemorragic risk of acenocoumarol versus warfarin in 2 groups of patients on preventive anticoagulation because of atrial fibrilation (international normalised ratio [INR]: 2-3) Patients And Method: Data on 120 patients treated with acenocoumarol and 120 on warfarin treatment who had started and continued treatment in our hospital for a minimum of a year was collected. Results: The percentage of visits within the intended range of INR (2 to 3) was 65.5% with warfarin and 63.4% with acenocoumarol. Thirty percent of patients on warfarin had 75% or more of their controls within range, while for those treated with acenocoumarol this percentage was 22.5%. In the acenocoumarol group, 0.3 visits/patient/year presented an INR≥6 versus 0.07 in the warfarin group (p=0.003). Conclusions: Patients treated with acenocoumarol show a higher risk of presenting with an INR ≥ 6, but no statistically significant differences are observed in therapeutic stability

Plasmocitoma solitario extramedular de localización perianal / Solitary extramedullary plasmocytoma in the perianal area

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Revisión de la profilaxis infecciosa en pacientes esplenectomizados en la Isla de Menorca / Review of infectious prophylaxis in splenectomized patients in Menorca island. Spain

FUNDAMENTO: Las infecciones graves son una de las complicaciones más importantes en los pacientes esplenectomizados. PACIENTES Y MÉTODO: Se ha realizado un estudio retrospectivo de los pacientes esplenectomizados en Menorca desde 1978 hasta febrero de 2000 para conocer el cumplimiento y grado de conocimiento de las recomendaciones de profilaxis infecciosa después de la esplenectomía. Se identificó a 75 pacientes. RESULTADOS: Un 62,7 por ciento de los pacientes recibieron la vacuna antineumocócica y conocían los riesgos infecciosos.CONCLUSIONES: La evolución mortal de algunas infecciones en pacientes esplenectomizados hace necesario que los médicos aumenten las medidas para su prevención y detección (AU)