CLINICAL NEWS
On Location
American Society of Hematology’s
2018 ANNUAL MEETING & EXPOSITION
he 2018 ASH Annual Meeting
& Exposition featured practice-
changing research from across
the spectrum of hematologic
malignancies and blood disorders.
In this issue, ASH Clinical News is taking
a look at the late-breaking abstracts
presented at the meeting, including a new
rapid screening tool for sickle cell disease,
a safe strategy for interrupting direct oral
anticoagulants for surgery, and a potential
new standard combination for transplant-
ineligible myeloma.
Visit ashclinicalnews.org/on-location for
our complete coverage of the meeting.
ASH Clinical News also spoke with
presenters and moderators about the
groundbreaking research that was shared at
the meeting. Watch all of the interviews at
ashclinicalnews.org/multimedia.
And look for more coverage in our special
issue in mid-January, where we’ll take a deep
dive into the 2018 ASH Annual Meeting.
ASHClinicalNews.org
Rivaroxaban Reduces
Thrombotic Risk in Patients
Undergoing Cancer Treatment
Primary prevention with the direct oral anticoagulant (DOAC) rivaroxaban reduced
venous thromboembolism (VTE) and VTE-related mortality in patients with cancer,
according to results from the placebo-controlled, randomized CASSINI trial, which were
presented as a late-breaking abstract at the 2018 ASH Annual Meeting. The benefit was
seen without an increase in major or clinically relevant bleeding events, lead investiga-
tor Alok A. Khorana, MD, from Cleveland Clinic in Ohio, noted.
“In 2018, most of our cancer treatment takes place in the outpatient setting, so most
of the clots occur in the outpatient setting,” Dr. Khorana explained. “From a public
health perspective, that is important because most of our [previous] efforts at preventing
blood clots have focused on the inpatient setting.”
The CASSINI trial is the first to assess the use of DOACs – which can be taken as a
daily pill at home – in patients who are actively receiving systemic chemotherapy.
Investigators enrolled 1,080 adult ambulatory patients with various cancers who
were initiating a new systemic regimen and who had an increased risk for VTE (defined
as a score ≥2 on the Khorana scale, which assigns risk for VTE based on cancer type,
hemoglobin level, and pre-chemotherapy platelet and leukocyte counts). Patients were
screened for deep-vein thrombosis (DVT) prior to randomization.
A total of 841 enrolled participants were randomized 1:1 to receive rivaroxaban 10
mg once daily or placebo for up to 180 days.
During the study period, patients were screened with lower-extremity ultrasounds
every eight weeks on study to test for symptomatic or asymptomatic lower-extremity
proximal DVT. The primary efficacy endpoint was a composite of DVT, pulmonary
embolism, and VTE-related death during the six-month observation period. As a sec-
ondary, prespecified endpoint, the investigators reviewed thrombotic risk during the on-
treatment period to account for patients with cancer who changed therapeutic regimens
or stopped anticoagulation.
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