Perspectives: Patient Management

Sebastian M. Schellong

Sebastian M. Schellong

MD

  • Professor of Medicine
  • Chief of Medical Department 2
  • Municipal Hospital Friedrichstadt
  • Dresden, Germany

Learnings from recent clinical trials data

The lessons to be learned depend on the trial results, and I think people are aware of these differences, and are incorporating these differences into their clinical reasoning and the strategy they choose for their own patients’ needs.

Bleeding is another factor, and it is getting more and more important, even in Germany. Bleeding risk awareness is increasing, and again, trial results provide figures for that. My perception is that many physicians, who may be unaware of current data, think that recent agents have a lower risk of bleeding compared to current regimens. This may not be the case, as there appear to be differences among them with data showing a tendency for more bleeding in certain patient populations. Moreover, the understanding of different bleeding risks among the general population of physicians is minimal, and there is a tendency to think these recent oral agents, as a whole, are associated with a lower bleeding risk.

Another lesson we learned from this is that oral drugs do not need laboratory testing. This can be judged as an advantage. However, I think what becomes an issue is renal insufficiency. In the last few years physicians felt free to administer low-molecular-weight heparin even to patients with impaired renal function. While certain drugs do allow for that, others do not, and there are increased tendencies to prescribe anticoagulants even in patients with impaired renal function.

Much caution is required when administering anticoagulants to patients with renal damage. I think that was a big lesson to learn, and while it was not the subject of the clinical trial report, I think, it should have been, because these trials excluded explicitly patients with severe renal impairment, and this is a very important factor.

Welcome to patient management

Welcome to patient management

Oral anticoagulation should consider individual patient differences and needs

About the Coagulation Center

The Coagulation Center is an educational resource for healthcare professionals. Guided by a global editorial board of experts, the Coagulation Center offers a range of clinical perspectives on balancing the benefit and risk of anticoagulation in a rapidly changing landscape. Within the Coagulation Center you will find roundtable discussions on anticoagulation management, materials for patient management including patient case studies, tools to help evaluate bleeding risk and stroke risk, and downloadable resources for your practice.