Dr. Schmaier on the Secondary Management of Thrombosis in Hematologic Malignancies

Alvin H. Schmaier, MD, professor in the Department of Medicine and the Department of Pathology at Case Western Reserve University School of Medicine, discusses the secondary management of thrombosis in patients with hematologic malignancies.

The goal of secondary management is to ensure the patient does not have excess bleeding, says Schmaier.

In May 2018, the FDA granted an accelerated approval to the coagulation factor Xa antidote andexanet alfa (Andexxa) for patients treated with rivaroxaban (Xarelto) and apixaban (Eliquis). The drug is indicated for patients who need to reverse anticoagulation due to life-threatening or uncontrolled bleeding.

While the agent has not been studied in a randomized clinical trial, its approval has helped fulfill an unmet clinical need in this space.

Prothrombin complex concentrates are also available agents for these patients, explains Schmaier. Though these agents have not been FDA approved, multinational clinical trials have demonstrated their efficacy, and they are considered the standard of care in this space.