Results from the largest study to date on the use of thromboprophylaxis in cancer patients on chemotherapy were published this week in the Feb. 16^th issue of the New England Journal of Medicine. Since cancer increases the risk of VTE, which is further increased by chemotherapy, this paper stirs up the debate surrounding the use of routine thromboprophylaxis in these patients. The SAVE-ONCO study found that use of a hemisynthetic ultra-low-molecular-weight heparin (ultra-LMWH), semuloparin (Visamerin, Sanofi), in cancer patients who were starting chemotherapy experienced significantly fewer thromboemobolic events without an increased risk of clinically-relevant bleeding. However, the study ultimately may not have put to rest the role of risk stratification for VTE prophylaxis, since the absolute risk of VTE was quite low overall, and some subgroups, such as those with ovarian cancer, experienced almost no events.

- Deborah

At the Canadian Cardiovascular Congress (CCC) this year, transcatheter aortic valve implantation (TAVI) received quite a bit of attention. I was surprised to even see this new technique discussed on an episode of Gray’s Anatomy a few weeks after the CCC. TAVI is a relatively novel procedure (the first TAVI was performed in humans in 2002) and is currently indicated for inoperable or high-risk patients with aortic valve stenosis.

A recent article published in the Journal of the American College of Cardiology: Cardiovascular Interventions reported that operator efficiency improves rapidly over the first 30 TAVI cases, before reaching a plateau. Dr. Oluseun Alli (Mayo Clinic, Rochester, MN) and colleagues clustered their first 44 patients who underwent TAVI procedures in the PARTNER trials, between November 2008 and May 2011, into chronological tertiles. From the first to the third tertile they observed a decline in median contrast volume and radiation doses, in addition to a reduction in the elapsed time between valvuloplasty of the defective valve to deployment of the new valve. While reduced fluoroscopy and radiation exposure improves the safety of the procedure, the authors did not observe a difference in vascular complication rates, length of hospital stay or mortality across the three tertiles. The authors commented on the importance of rigorous training and proctorship in adoption of this novel technique, and predicted that simulators, industry-sponsored training, proctorships and dedicated fellowship training programs will play key roles in the future.

- Deborah

An iPad application has recently been developed to collect data during coronary catheterization procedures and send the information to the iPad. Shared with patients and their families, this tool can allow physicians to communicate more effectively and in some cases may enable them to show the interventional procedure as it unfolds. The visual presentation of the diagnostics and the procedure can benefit both the patient-physician relationship, and also provides the opportunity for cardiologists to communicate on-line, at a high-level, around the world. The app was developed by Dr. Ran Kornowski of the Invasive Cardiology Institute of Rabin Medical Center, in Israel, along with the McKesson Corporation, a healthcare information-technology company. It was designed to protect patient information and be fast enough for point-of-care, and provides high-quality radiology images. This story shows how the iPad, and other table devices, are slowly being integrated into healthcare to improve communication, physician and patient education, access to information, and ultimately the quality of care.

- Deborah

A study published today in the Lancet from the randomised Heart Protection Study (HPS) confirmed that statins are not associated with an increased risk of cancer or mortality from non-vascular causes. The study also showed that the benefits of statin therapy continued for several years after discontinuation of treatment. These results are reassuring for both clinicians and patients, particularly in light of prior studies which suggested an increased cancer risk with statin therapy. See the Lancet for the full article: http://www.thelancet.com/.

 - Deborah