Using patient education to reduce risk of VTE
Benefits Of Indefinite Anticoagulant Unclear After First VTE
For patients with a first unprovoked venous thromboembolism (VTE), indefinite anticoagulation prevents some recurrent VTE events but induces additional major bleeding events, according to a study published online June 27 in the Annals of Internal Medicine.
Faizan Khan, Ph.D., from the University of Calgary in Canada, and colleagues estimated the benefit-harm tradeoffs of indefinite anticoagulation in patients with a first unprovoked VTE who completed three to six months of initial anticoagulant treatment.
The researchers found that in a hypothetical cohort of 1,000 patients aged 55 years, indefinite anticoagulation prevented 368 recurrent VTE events, including 14 fatal pulmonary emboli in the base-case analysis, but induced 114 major bleeding events, including 30 intracranial hemorrhages and 11 deaths from bleeding. The cost of indefinite anticoagulation was $16,014 (in Canadian dollars) more per person, and did not increase quality-adjusted life years. In the sensitivity analysis, during extended anticoagulation, the model results were most sensitive to the case-fatality rate of major bleeding and the annual risk for major bleeding.
"Continuing versus discontinuing anticoagulation indefinitely in all (that is, unselected) patients with a first unprovoked VTE has little chance of improving life expectancy but might provide a mortality benefit in certain subgroups," the authors write.
More information: Faizan Khan et al, Indefinite Anticoagulant Therapy for First Unprovoked Venous Thromboembolism, Annals of Internal Medicine (2023). DOI: 10.7326/M22-3559
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Inari Medical (NARI) Launches New Catheters To Address VTE
Inari Medical, Inc. NARI recently announced the commercial launch of two new purpose-built products, the RevCore thrombectomy catheter and the Triever16 Curve catheter. RevCore is currently the first mechanical thrombectomy device designed to address venous in-stent thrombosis, whereas the Triever16 Curve catheter is the latest addition to Inari Medical's FlowTriever platform.
The latest launches are expected to significantly solidify Inari Medical's foothold in the Venous Stent Thrombosis and Venous Thromboembolism (VTE) treatment space globally.
Significance of the LaunchPer Inari Medical's estimates, approximately half a million venous stents have been placed in the United States in the past few years. However, the company also confirmed that venous in-stent thrombosis is an increasingly common occurrence, affecting more patients every year. Inari Medical believes that RevCore will likely be able to address this issue as this is a solution for an entirely new patient pool, which is not currently addressed by the ClotTriever or FlowTriever platforms.
Per Inari Medical, the Triever16 Curve catheter, which features a pre-shaped curve for targeted aspiration, is purpose-built to be versatile for both pulmonary embolism and peripheral thrombectomy. Triever16 Curve offers unique advantages over 16F continuous aspiration catheters, including compatibility with the FlowSaver blood return system and simple access to larger, more powerful 20F or 24F catheters within the company's price-per-procedure model.
An expert familiar with RevCore believes that it is an innovative tool as it physically removes in-stent thrombus and restores flow. It could also potentially reduce the need for additional reintervention. Another medical personnel commented that with the availability of the Triever16 Curve catheter, a wider VTE patient population will likely be served.
Industry ProspectsPer a report by Future Market Insights, the global VTE treatment market was estimated to be $1.53 billion and is anticipated to reach $1.91 billion in 2029 at a CAGR of 3.7%. Factors like the increasing pervasiveness of cardiovascular diseases and cancer due to the adoption of smoking and increasing obesity rate, the rising elderly population and technological advancements are likely to drive the market.
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Given the market potential, the commercial launches are likely to provide a significant boost to Inari Medical's business globally.
Notable DevelopmentsLast month, Inari Medical announced planned enrollment of the PEERLESS II trial, its third randomized controlled trial (RCT) in VTE. PEERLESS II is a prospective, global, multi-center RCT comparing the outcomes of intermediate-risk pulmonary embolism (PE) patients treated with the FlowTriever system versus anticoagulation alone.
The same month, Inari Medical announced its first-quarter 2023 results, wherein it registered a solid uptick in its year-over-year revenues. Management also confirmed the receipt of FDA clearances for several new products that are expected to drive market expansion while safeguarding the company from both existing and future competition.
In March, Inari Medical announced positive results from the FLAME study in high-risk/massive PE. FLAME is the largest prospective study of interventional treatment in high-risk PE, a patient population with a historical mortality rate of 25-50%.
Price PerformanceShares of the company have lost 6.7% in the past year against the industry's 4.3% rise and the S&P 500's 6.4% growth.
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Zacks Rank & Key PicksCurrently, Inari Medical carries a Zacks Rank #3 (Hold).
Some better-ranked stocks in the broader medical space are Hologic, Inc. HOLX, Merit Medical Systems, Inc. MMSI and Boston Scientific Corporation BSX.
Hologic, carrying a Zacks Rank #2 (Buy) at present, has an estimated growth rate of 5.1% for fiscal 2024. HOLX's earnings surpassed estimates in all the trailing four quarters, the average being 27.3%. You can see the complete list of today's Zacks #1 Rank (Strong Buy) stocks here.
Hologic has gained 6.9% compared with the industry's 4.3% rise in the past year.
Merit Medical, carrying a Zacks Rank #2 at present, has an estimated long-term growth rate of 11%. MMSI's earnings surpassed estimates in all the trailing four quarters, the average surprise being 20.2%.
Merit Medical has gained 45.9% compared with the industry's 10.5% rise over the past year.
Boston Scientific, carrying a Zacks Rank #2 at present, has an estimated long-term growth rate of 11.5%. BSX's earnings surpassed estimates in two of the trailing four quarters and missed in the other two, the average surprise being 1.9%.
Boston Scientific has gained 33.5% against the industry's 29.8% decline over the past year.
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New CHEST Guideline Offers Recommendations To Manage Arterial Thrombosis And Thromboembolism In COVID-19
The American College of Chest Physicians® (CHEST) recently released a new clinical guideline on antithrombotic therapy in arterial thrombosis and thromboembolism in COVID-19. Published in the journal CHEST®, the guideline contains 11 evidence-based recommendations to improve risk-evaluation and to assist in determining the course of treatment.
While there are guidelines for the management of COVID-19-related coagulopathy for venous thromboembolism (VTE), a recent large cohort study showed that COVID-19 was associated with substantially increased incidence of both VTE and arterial thromboses, including myocardial infarction and stroke.
The new guideline provides recommendations for managing four arterial (pro)thrombotic medical conditions so that when a patient presents with COVID-19 infection either with an acute thrombotic event or a history of them, the clinician will be able to assess the risks and benefits of administering additional medication that may interact with a current antithrombotic, as well as the need for modification of current antithrombotic therapy. By addressing these interactions and risks in a guideline, we can better prepare clinicians to make informed decisions on their treatment plan and standardize care."
Tatjana Potpara, MD, PhD, FESC, lead author on the guideline
The guideline includes the conditional recommendations relating to:
1) acute coronary syndrome/percutaneous coronary intervention,2) a history of or acute stroke or transient ischemic attack,3) previously known or newly diagnosed atrial fibrillation, and4) peripheral artery disease/acute limb ischemia.
The recommendations include:
The existing evidence and panel consensus do not suggest a major departure from the management of arterial thrombosis as per pre-COVID-19 recommendations. Data on the optimal strategies for prevention and management of arterial thrombosis and thromboembolism in patients with COVID-19 are sparse, and more high-quality evidence is needed to inform management strategies in these patients.
The entire list of recommendations included in the new guideline can be accessed through the CHEST journal website.
Source:
Journal reference:
Potpara, T., et al. (2023) Antithrombotic therapy in arterial thrombosis and thromboembolism in COVID-19: An American College of Chest Physicians Expert Panel Report. CHEST Journal. Doi.Org/10.1016/j.Chest.2023.06.032.
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