Characterization of direct oral anticoagulants use in adult hematopoietic stem cell transplant recipients.

Direct oral anticoagulants (DOACs) for venous thromboembolism (VTE) treatment are of interest in oncology due to ease of administration and lack of need for therapeutic monitoring compared to other anticoagulants. Data supporting their use in patients with hematologic malignancies post-hematopoietic stem cell transplant (HCT) are limited. The purpose of the study is to characterize DOAC use in HCT patients. This multicenter, retrospective cohort analysis included allogeneic and autologous HCT recipients. The primary outcome was major bleeding. Secondary outcomes included clinically relevant non-major bleeding (CRNMB)/minor bleeding and VTE recurrence. Of 126 patients, 91 (72.2%) patients received an autologous HCT, and 35 (27.8%) patients received an allo-HCT. No major bleeding occurred in either transplant recipient groups. In autologous HCT recipients, CRNMB/minor bleeding occurred in four (4.4%) patients and VTE recurrence occurred in one (1.1%) patient. For allogeneic HCT recipients, CRNMB/minor bleeding occurred in five (14.3%) patients and VTE recurrence occurred in two (5.7%) patients. For patients that experienced a CRNMB, five (100%) of the allogeneic HCT and two (50%) of the autologous HCT recipients were thrombocytopenic at the time of bleeding. Only 38.5% of patients who experienced a drug-drug interaction requiring DOAC dose adjustment received the appropriate dose adjustment. DOACs were associated with low rates of recurrent VTE and no major bleeding events, similar to published data on DOAC use in the general cancer patient population. This suggests that DOACs may be safe therapeutic options with proactive management of drug interactions and careful monitoring for bleeding events, especially in the allogeneic HCT population where minor bleeding rates were slightly higher.

Regenerative injection therapy for osteoarthritis: fundamental concepts and evidence-based review.

Regenerative therapy involves the injection of a small volume of solution into multiple sites of painful ligament and tendon insertions (entheses) and adjacent joint spaces, with the goal of reducing pain and ostensibly promoting tissue repair and growth. Dextrose and platelet-rich plasma solutions have been shown to increase expression of growth factors in vivo and have shown promising clinical results in the treatment of tendinosus. In the treatment of osteoarthritis, small clinical trials and case series to date suggest safety, symptomatic improvement, and functional improvement at up to a year of follow-up; however, most of these studies are uncontrolled. Given the methodological limitations of clinical research on regenerative injections for osteoarthritis to date, this treatment should be considered only after execution of a comprehensive assessment and treatment plan, including optimization of biomechanics, weight loss, cardiovascular exercise, resistance training, and judicious use of more established topical, oral, and injectable medications.

Applications of platelet-rich plasma in musculoskeletal and sports medicine: an evidence-based approach.

This article aims to provide a comprehensive review of the current literature that pertains to the therapeutic use of autologous platelet-rich plasma (PRP). The basic science literature regarding the role of growth factors in mediating the healing process and the laboratory data from in vitro and in vivo studies that evaluated PRP are reviewed. Subsequently, the current evidence regarding PRP efficacy from animal models, human surgical studies, and human clinical studies is presented. A critical analysis of the literature follows, and the article concludes with the authors' perspectives on the state of PRP as a potentially efficacious bioregenerative treatment option for musculoskeletal and sports medicine applications. The relevant articles in this review were obtained via PubMed literature searches for PRP publications that pertain to musculoskeletal and sports medicine conditions. This article is not intended to be a formal meta-analysis.

Effective Conservative Treatment for Chronic Low Back Pain.

Evidence suggests that effective conservative treatment is available for chronic low back pain. The effectiveness of conservative treatment has recently received attention following publication of several randomized controlled trials (RCTs) that reported similar improvements in outcomes from cognitive intervention with exercise as from spinal fusion surgery. This paper will explore the conservative treatment arms of these RCTs with the goal of educating the reader about the principles of cognitive intervention with exercise. These principles can be incorporated into the care of chronic low back pain patients both as primary treatment and as a means of augmenting surgical outcomes.

Changes in stroke rehabilitation outcomes after the implementation of Japan's long-term care insurance system: a hospital-based study.

OBJECTIVE: To explore the changes in stroke rehabilitation outcomes after the introduction of Japan's long-term care insurance (LTCI) system. DESIGN: Stroke patients discharged during a 3-yr period before and after the implementation of LTCI were compared (before-LTCI vs. after-LTCI). Outcome measures included onset to admission interval, length of stay, and correlation between discharge site and functional level at discharge. RESULTS: A total of 201 patients in the before-LTCI group and 252 patients in the after-LTCI group were eligible for the study. Shorter mean length of stay (P < 0.01) and higher rates of discharge to a rehabilitation facility (P < 0.01) were found in the after-LTCI group. Logistic regression analysis revealed that the patients with higher activities of daily living scores or ambulatory status at discharge were more likely to be discharged to home after inpatient rehabilitation in both groups (P < 0.01). The rate of discharge to home was similar in both groups. CONCLUSIONS: Within this rehabilitation hospital's experience, the mean length of stay was reduced after the implementation of the LTCI. Although it was one of the primary goals of the LTCI, the rate of discharge to home did not significantly increase. Further evaluation and modification of the LTCI and more efforts to improve a patient's activities of daily living and ambulatory status at discharge will be necessary to promote in-home care in Japan.