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The Specialist Journal Club: Concluding Remarks
Welcome to the UBC Specialist Journal Club in Internal Medicine, 2012-13!
Well, as the sun stays longer in the sky the journal club has reached its final session, just in time for you to enjoy a bit of the great BC outdoors instead of slaving away on your computer.
Overall I hope you enjoyed the journal club and most of all took something away from the topics presented.
I would like to thank you and all the support staff here, especially Stephanie Ameyaw who supported us throughout the whole journal club.
On a concluding note we would welcome your comments on what you would like to see in the future in terms of topics and how these are presented. Things such as the use of case studies, more clinical and less journal related topics or vice versa, the use of other media such as video conferencing, group sessions for discussion, etc. Please take the time to complete the short survey that you will receive by email and share your ideas on future components of the club.
We would like to develop a forum where ease of use is balanced with learning and engagement so ideas are welcome.
Again thanks and see you next year.
Chester.
Points to Ponder: Rivaroxiban Approved for use in Canada for Pulmonary Embolus
Hi Everyone,
I was at a conference in April and learned that the use of rivaroxiban was approved (Apr 19) for use in Canada for pulmonary embolus.
This is from bayer:
http://www.bayer.ca/files/NR%20Xarelto%20PE%202013%2004%2018%20FINAL.pdf
What are people thinking about the EINSTEIN Clinical Trial Programme and the implications of rivaroxiban’s approval?
Lets Discuss!
Points to Ponder: Short Half Life and Reversibility
How much of an issue is the lack of reversibility for you given the short half life of this agent?
Points to Ponder: Practice Change
What would be your enthusiasm for implementing this drug in your practice for this indication? Are longer term studies needed?
Points to Ponder: Discussions on Representative Sampling
Some have criticized the study for having a relatively young average age at 57.9 years but subgroup analysis actually shows greater benefit to the rivaroxaban with those greater than 75 having less bleeding events. Do you feel the sample is representative?
Welcome to Session 5!
Hi all,
Hope Spring has sprung in your hometown.
For the last session the journal club we will review a paper for the NEJM from 2012, “Oral rivaroxaban for treatment of symptomatic pulmonary embolism”.
This is interesting as it has led to the approval of the medication for this indication in Europe and the USA. In addition recent articles on apixaban and dabigatran have been published looking at these agents in venous thromboembolism. Please also see references below.
Learning objectives:
1) Review data for new agents for the treatment of thromboembolism
2) Evaluate and comment on the potential use of these agents in your practice
3) Comment on the study of rivaroxaban in pulmonary embolism
ARTICLE:
Oral Rivaroxaban for the Treatment of Symptomatic Pulmonary Embolism. N Engl J Med. 2012;366:1287-1297. Use this link to access the article: https://blogs.ubc.ca/imjournalclub/files/2013/04/Pulmonary-Embolisim.pdf
Additional Readings:
Apixaban for Extended Treatment of Venous Thromboembolism
Giancarlo Agnelli, M.D., Harry R. Buller, M.D., Ph.D., Alexander Cohen, M.D., Madelyn Curto, D.V.M., Alexander S. Gallus, M.D., Margot Johnson, M.D., Anthony Porcari, Ph.D., Pharm.D., Gary E. Raskob, Ph.D., and Jeffrey I. Weitz, M.D. for the AMPLIFY-EXT Investigators
N Engl J Med 2013; 368:699-708February 21, 2013DOI: 10.1056/NEJMoa1207541
Extended Use of Dabigatran, Warfarin, or Placebo in Venous Thromboembolism
Sam Schulman, M.D., Ph.D., Clive Kearon, M.D., Ajay K. Kakkar, M.B., B.S., Ph.D., Sebastian Schellong, M.D., Henry Eriksson, M.D., Ph.D., David Baanstra, M.Sc., Anne Mathilde Kvamme, M.Sc.Pharm., Jeffrey Friedman, M.D., Patrick Mismetti, M.D., and Samuel Z. Goldhaber, M.D. for the RE-MEDY and the RE-SONATE Trials Investigators
N Engl J Med 2013; 368:709-718 February 21, 2013DOI: 10.1056/NEJMoa1113697
Points to Ponder: Change of practice
Does studies such as this one change your practice in this area? How would you implement this if it does? Are there barriers to implementation?
Points to Ponder: Study validity
Given the large sample size and results is there need for more reseach around the association between tropinin and mortality? If so what questions are still needing validation?
Points to Ponder: Troponin screening
Do you use troponin screening in your current practice? If so in what way? Is 4th generation TnT avalable to you?