Freddy Frost, research fellow in cystic fibrosis in Liverpool, and Alex Pickard, trainee in acute and emergency medicine in South London, return to The Rounds Table this week. Together they cover apixaban therapy to prevent venous thromboembolism (VTE) in patients with cancer, and omadacycline for treatment of community-acquired bacterial pneumonia (the OPTIC trial).
Patients with active malignancy have increased risk of VTE and this is associated with significant morbidity and mortality. Novel oral anticoagulants (NOACs) are being used more frequently for treatment of VTE – what about for the prophylaxis of VTE specifically associated with cancer? Freddy covers a trial assessing the efficacy and safety of apixaban for thromboprophylaxis compared to placebo in patients with cancer who were at intermediate-to-high risk for VTE and were initiating chemotherapy.
Community-acquired pneumonia is one of the leading causes of mortality in the world, especially among the elderly. There is a need for novel antibiotics given the development of resistant infections. Omadacycline is a new aminomethylcycline antibiotic that overcomes some of the mechanisms of tetracycline resistance. Alex reviews a trial comparing the safety and efficacy of omadacycline to moxifloxacin for the treatment of adults with community-acquired bacterial pneumonia.
Finally, The Good Stuff segment. Freddy shares an article on understanding the use of lactate in sepsis and Alex highlights a review on tips and tricks for in-flight medical emergencies.
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1. Apixaban for VTE prevention: https://www.nejm.org/doi/full/10.1056/NEJMoa1814468
2. OPTIC trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1800201
2. In-Flight emergencies: https://jamanetwork.com/journals/jama/article-abstract/2719313
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