Miheer

Probably yes, but in reading up on it I realized the data isn’t as robust as pharm ppx in other settings, that for DOACs we’re extrapolating from this already slim data base, and that compression stockings actually have a fair amount of data!

Shoutout to whoever at Mayo made this graphic of the general myeloma treatment paradigm.

I’ve found it incredibly useful helpful to give the 10,000ft view at initial diagnosis.

#HemeSky #OncSky #mmsm

Source: www.mayoclinic.org/medical-prof...

Venous thrombosis from air travel: the LONFLIT3 study--prevention with aspirin vs low-molecular-weight heparin (LMWH) in high-risk subjects: a randomized trial - PubMed The LONFLIT1 and 2 studies established that in high-risk subjects after long (>10 hours) flights, the incidence of deep venous thrombosis (DVT) may be between 4% and 6%, The LONFLIT3 study aimed to ev...

To quantify that a bit - in the LONFLIT3 trial the rate of recurrent VTE for high risk travelers was:

No ppx: 4.8%
ASA: 3.6%
LMWH: none

There’s probably stronger data for compression stockings than aspirin, though I don’t think they have been directly compared.

pubmed.ncbi.nlm.nih.gov/11863301/

From an EBM perspective there isn’t much beyond the standard “walk around occasionally and stay hydrated” for those who aren’t in one of those high risk groups.

Practically there’s little risk to a dose of aspirin for most people, but there’s also little benefit in preventing VTE.

The data for LMWH is limited to one RCT, and despite there being no prospective data for DOACs it’s reasonable to think they would work just as well.

This ASH clinical news article delves into DOACs, and some of the myths about VTE and travel.

ashpublications.org/ashclinicaln...

Although the data isn’t robust, the 2018 ASH VTE guidelines give some suggestions:

A) for the average person: no ppx

B) if high risk and travel >4h: compression stockings OR LMWH ppx.

(If unable to do either of those, full dose aspirin is better than nothing)

ashpublications.org/bloodadvance...

Consult from this week:

Would you recommend any preventative measures before an international flight for someone who had a PE provoked by an 8h road trip in 2012 treated with 3 months of warfarin?

#HemeSky #MedSky

JAK2 unmutated erythrocytosis: 2023 Update on diagnosis and management - PubMed Advances in molecular hematology might result in better characterization of "idiopathic erythrocytosis" and expansion of the repertoire for germline mutations in hereditary erythrocytosis. Prospective...

The most challenging thing for me in erythrocytosis/polycythemia workups has been thinking about all of the possible etiologies when the JAK2/CALR/MPL testing comes back negative.

This article is GOLD.

#HemeSky #MedSky

pubmed.ncbi.nlm.nih.gov/36966432/