memo - Magazine of European Medical Oncology

, Volume 7, Issue 3, pp 126–129

Highlights of the American Society of Hematology Meeting 2013: hemostaseology

short review


Venous thromboembolism is associated with substantial morbidity and mortality. Furthermore, the subsequently indicated anticoagulation treatment puts the patient at risk of possible bleeding complications. Therefore, improving treatment strategies as well as diagnostic approaches can optimize patient care. During the 55th Annual Meeting 2013 of the American Society of Hematology the Choosing Wisely® campaign was presented. An expert committee recommends against the test for thrombophilia after venous thromboembolism occurring in the setting of major transient risk factors to avoid over treatment in these patients. Other presentations focused on the use of the direct oral anticoagulants in patients with cancer-associated thromboembolism. However, specific studies comparing direct oral anticoagulants with the state-of the art treatment with low molecular heparins in cancer-associated thromboembolism are still missing. Finally, age-adjusted cut-off levels can increase the specificity of D-Dimer in older patients. Consequently, using clinical probability assessment in the combination with age-adjusted D-dimer cut-off levels may be associated with a larger number of patients in whom pulmonary embolism can be ruled out.


Thrombophilia screening Venous thromboembolism Cancer Anticoagulation Age-adjusted D-dimer 



American Society of Hematology


Direct oral anticoagulant


Low-molecular-weight heparin


Unfractionated heparin


Vitamin K antagonist


Venous thromboembolism


  1. 1.
    Hicks LK, Bering H, Carson KR, et al. The ASH Choosing Wisely(R) campaign: five hematologic tests and treatments to question. Blood. 2013;122:3879–83.PubMedCrossRefGoogle Scholar
  2. 2.
    Crowther MA, Ageno W, Garcia D, et al. Oral vitamin K versus placebo to correct excessive anticoagulation in patients receiving warfarin: a randomized trial. Ann Intern Med. 2009;150:293–300.PubMedCrossRefGoogle Scholar
  3. 3.
    Crowther MA, Garcia D, Ageno W, et al. Oral vitamin K effectively treats international normalised ratio (INR) values in excess of 10. Results of a prospective cohort study. Thromb Haemost. 2010;104:118–21.PubMedCrossRefGoogle Scholar
  4. 4.
    Baglin T, Luddington R, Brown K, Baglin C. Incidence of recurrent venous thromboembolism in relation to clinical and thrombophilic risk factors: prospective cohort study. Lancet. 2003;362:523–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Kyrle PA, Minar E, Bialonczyk C, et al. The risk of recurrent venous thromboembolism in men and women. N Engl J Med. 2004;350:2558–63.Google Scholar
  6. 6.
    Kyrle PA, Eischer L. Predicting the risk of recurrent venous thromboembolism. The Austrian study on recurrent venous thromboembolism (AUREC). Hamostaseologie. 2013;33:201–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Kyrle PA, Rosendaal FR, Eichinger S. Risk assessment for recurrent venous thrombosis. Lancet. 2010;376:2032–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e419S–94S.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Schulman S, Kearon C, Kakkar AK, et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med. 2009;361:2342–52.Google Scholar
  10. 10.
    Schulman S, Kearon C, Kakkar AK, et al. Extended use of dabigatran, warfarin, or placebo in venous thromboembolism. N Engl J Med. 2013;368:709–18.Google Scholar
  11. 11.
    Buller HR, Decousus H, Grosso MA, et al. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med. 2013;369:1406–15.Google Scholar
  12. 12.
    Schulman S, Kakkar AK, Goldhaber SZ, et al. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation. 2014;129:764–72.PubMedCrossRefGoogle Scholar
  13. 13.
    Lee AY, Levine MN, Baker RI, et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med. 2003;349:146–53.Google Scholar
  14. 14.
    Blot E, Gutman F, Thannberger A. Dalteparin compared with an oral anticoagulant for thromboprophylaxis in patients with cancer. N Engl J Med. 2003;349:1385–7.Google Scholar
  15. 15.
    Rose AJ, Sharman JP, Ozonoff A, Henault LE, Hylek EM. Effectiveness of warfarin among patients with cancer. J Gen Intern Med. 2007;22:997–1002.Google Scholar
  16. 16.
    Short NJ, Connors JM. New oral anticoagulants and the cancer patient. Oncologist. 2014;19:82–93.PubMedCrossRefGoogle Scholar
  17. 17.
    Farge D, Debourdeau P, Beckers M, et al. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. J Thromb Haemost. 2013;11:56–70.Google Scholar
  18. 18.
    Lyman GH, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: american society of clinical oncology clinical practice guideline update. J Clin Oncol. 2013;31:2189–204.PubMedCrossRefGoogle Scholar
  19. 19.
    Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135:98–107.Google Scholar
  20. 20.
    van Belle A, Buller, Huisman MV, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA. 2006;295:172–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Klok FA, Mos IC, Nijkeuter M, et al. Simplification of the revised Geneva score for assessing clinical probability of pulmonary embolism. Arch Intern Med. 2008;168:2131–6.Google Scholar
  22. 22.
    Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the task force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Heart J. 2008;29:2276–315.Google Scholar
  23. 23.
    Walston J, McBurnie MA, Newman A, et al. Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study. Arch Intern Med. 2002;162:2333–41.Google Scholar
  24. 24.
    Schouten HJ, Geersing GJ, Koek HL, et al. Diagnostic accuracy of conventional or age adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: systematic review and meta-analysis. BMJ. 2013;346:f2492.Google Scholar
  25. 25.
    Righini M, Van EJ, den Exter PL, et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA. 2014;311:1117–24.Google Scholar

Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  1. 1.Internal Medicine V—Hematology and OncologyMedical University of InnsbruckInnsbruckAustria

Personalised recommendations