Use of apixaban in children awaiting heart transplantation

BACKGROUND

The use of apixaban in the pediatric cardiac population is expanding. We describe our apixaban dosing and monitoring strategy in children and young adults awaiting heart transplantation, along with outcomes related to bleeding and thrombosis during wait-list and early post-transplant periods.

METHODS

This study is a retrospective, single-center analysis of all patients receiving apixaban while awaiting cardiac transplantation. Weight-based dosing was monitored with peak drug-specific anti-Xa chromogenic analysis. Significant post-operative bleeding defined by chest tube output or need for surgical intervention.

RESULTS

From September 2020 to December 2022, 19 patients, median age 13.5 years (6.1, 15.8 years), weighing 48.9 kg (15.4, 67.6) received apixaban while awaiting transplant. Indication for apixaban was prophylaxis (n = 18, 3 with ventricular assist devices) and treatment of thrombus (n = 1). There were no clinically relevant non-major or major bleeding, nor thrombotic events while awaiting transplant. The median time from last apixaban dose to arrival in the operating room was 23.2 h (15.6-33.8), with median random apixaban level of 37 ng/mL (28.3, 59), 6.3 h (4.8, 8.4) prior to arrival in the operating room. In this study, 32% of patients had significant post-operative bleeding based on chest tube output post-transplant or need for intervention. No patients meeting criteria for significant post-operative bleeding were thought to be attributable to apixaban.

CONCLUSIONS

Careful use of apixaban can be safe and effective while awaiting heart transplant. There was no appreciable increase in peri-operative bleeding. The use of apixaban is promising in providing safe, predictable and efficacious anticoagulation while avoiding additional patient stressors.

Abstract 203: Adoptions of Smartphones, Tablets, and Mobile Applications Among Patients with Hypertension

optimize management, monitoring, and therapy compliance in patients with hypertension (HTN). It could potentially prevent unnecessary emergency room visits and hospital admissions.

Methods: We surveyed patients with HTN in cardiology and primary care clinics regarding their use of mobile technology.

Results: 148 patients were included (79 female; age 16-64: 47%, >65: 53%, 70 male; 18-64:41%, >65: 59%). Associated diagnosis were coronary artery disease (21%), myocardial infarction (13%), arrhythmias (36%), heart failure (6%), or other forms of heart disease (3%). 83% own a cell phone, 29% are smartphones. 78% own a personal computer, laptop, iPod, or tablet. 35% report using APPS, of which 26% use health-related applications. 2% used APPS for blood pressure monitoring or management. 17% used APPS for diet or calorie counters, 13% for exercise, fitness or heart monitoring. 63% use APPS on a smartphone, 12% on iPod Touch, 62% on Tablet. Among all HTN patients surveyed, 64% report looking up medical information online on a computer, 53% more than once per month. When asked about willingness to pay, 44% were not willing to pay for a smartphone or tablet that would help monitor their condition. 61% were not willing to pay if an ER visit and its copayment could be prevented. 26% were not willing to use these devices if they were free or covered by insurance.

Conclusions: A majority of HTN patients surveyed had access to technology with 22% using smartphones with APPS. However, there was limited use of health-specific APPS, especially those related to HTN. Limiting factors may include lack of outcomes-based research, structured programs that incorporate APPS and devices, or lack of familiarity with APPS and technological devices. A comprehensive strategy to develop, market, and demonstrate benefits of this rapidly growing technology is urgently needed.

[Cerebrovascular accident: differential diagnosis of a compressive spinal hematoma]

We report the case of a 84-year-old patient who developed a monoplegia of the left inferior limb after a spinal anaesthesia for femoral neck's fracture. The magnetic resonance imaging (MRI) carried out in emergency, eliminated a spinal compression. The final diagnosis was a cerebral stroke. This observation leads us to discuss the choice of anaesthesia technical, the various aetiologies of a neurological trouble after spinal anaesthesia. The appearance of clinical signs evoking a spinal haematoma, must make seek by the imagery (MRI or scanner) the signs of spinal compression in order to propose an emergency laminectomy. Finally we insist on the importance but also on the difficulties of the clinical examination in elderly traumatic patients.

[Tolerance of influenza vaccination in the aged and the nursing staff in a geriatric hospital]

The tolerance of influenza vaccination (Vaxigrip, Pasteur-Mérieux) was evaluated during four consecutive years (1989-1992) in the geriatric hospital of Saint-Etienne from questionnaires concerning 327 vaccinations in the aged (group 1) and 88 vaccinations in members of the nursing staff (group 2). Minor local symptoms were the more common incidents, respectively for each group: blotch (9.8 and 21.6%), pain (9.2 and 47.7%), nodule (2.4 and 13.6%). Fatigue (4.0 vs 12.5%) and fever (6.1 vs 4.5%) were the more frequent among general symptoms, respectively in each group. No major vaccinal accident was recorded. These results underline that influenza vaccination is well tolerated, much more in aged people than in members of the nursing staff.

[Thrombotic thrombocytopenic purpura and ankylosing spondylarthritis. Apropos of a case]

The authors report a case of thrombotic thrombocytopenic purpura (TTP) which revealed a hitherto unrecognized ankylosing spondylitis. After a 4-year follow-up, the spondylitis is still progressing in its axial and/or peripheral form, and TTP has not relapsed. TTP is usually primary, but numerous forms consecutive to various diseases, and notably autoimmune diseases, have been reported. The TTP-ankylosing spondylitis association is extremely rare: analysis of the literature yielded only one case. The authors discuss the hypothesis of a common triggering factor.