Octapharma News April 13th, 2004

April 13th, 2004

Intensivists, Ice hockey and Innovation: a report from the 24th annual ISICEM congress

The International Symposium on Intensive Care and Emergency Medicine (ISICEM), held every year in March, in Brussels, is established as one of the largest congresses in its field and attracts more than 4600 participants from countries world-wide.

Octapharma supported the congress via participation in the commercial exhibition. Under the "Octapharma disc" delegates could find product information for Atenativ, Albumin, and Octaplas. In addition, several scientific paper reprints were available related to the use of the products.

On Wednesday, March 31st, a special emphasis on the booth was Atenativ. Delegates took the opportunity to play the Atenativ "inhibitors" table hockey game while learning how Atenativ works to inhibit the pathogenic coagulation process in disseminated intravascular coagulation (DIC).

Octapharma representatives presented the www.DICsepsis.org website. The website provides physicians, who encounter disseminated intravascular coagulation (DIC), with a unique opportunity to interact with independent, worldwide experts in the area of DIC. Delegates were invited to register for free full access membership. Click on the link above to sign up for free full access to the DICsepsis.org website. (Please note that clicking on the link above will take you outside of the Octapharma web site).

In addition, a competition was held in which delegates completed questions relating to a case analysis using the ISTH DIC scoring system. The winner of the lottery, Dr. Stefan Verstraete from Knokke, Belgium, won a USB memory stick.


	Professors Jørn Dalsgaard Nielsen, MD and Lars Heslet, MD answer questions from another physician from Italy.

A meet-the-experts session was offered twice during the day, entitled: The Role of Antithrombin in the coagulation process and in the treatment of DIC. Professor Jørn Dalsgaard Nielsen, manager of the Thrombosis Centre & Coagulation Laboratory at the Copenhagen County Hospital, Denmark and Professor Lars Heslet, who runs the largest Intensive Care Unit in Denmark at Rigshopitalet Hospital, performed a double act. They began by highlighting the two phases in the clinical course of DIC, the advantages of using antithrombin, and provided commentary on the subgroup analysis in the Kybercept trial. A lively crowd continued the discussion with questions following the presentation.

The following day, Thursday, April 1st, the focus was on Octaplas, our solvent detergent treated, pooled, fresh frozen plasma. Delegates learned how Octaplas was developed as an alternative to FFP in order to prevent virus transmission and to meet the need for a standardised, cell free and high quality coagulation active plasma for transfusion, thereby improving therapeutic accuracy and reducing adverse reactions.

A presentation about Transfusion Related Acute Ling Injury (TRALI) played throughout the day and allowed delegates to participate in a quiz about the condition. TRALI is one of the biggest causes of transfusion deaths, accounting for 15% of all fatal complications of blood transfusions, though it is often under recognised or misdiagnosed. There have been no reports of TRALI with Octaplas. The quiz asked questions specifically constructed to assist in the recognition of the TRALI. At the end of the day, a lottery produced the winner of the Octaplas TRALI quiz, Dr. Marja Hynninen from Finland, who also received a USB memory stick.

Dr. Khalid Al Khashan, a delegate from Kuwait said, "Octaplas is not yet registered in our country. We are anxiously awaiting its arrival as we believe it will have a significant impact on the health and safety of our patients."

Albumin was extensively discussed at the congress in the context of the great colloid/crystalloid debate, which has gone on for over 30 years. There may now be a partial answer available with the preliminary results of the saline versus albumin fluid evaluation (SAFE) study. In this randomized, controlled trial, approximately 7000 critically ill patients were given either saline or albumin and evaluated for 28-day mortality.


	Simon Finfer, lead investigator of the SAFE study, presenting at the 24th annualISICEM congress.

The lead investigator of the study, Dr. Simon Finfer, senior staff specialist in intensive care at Royal North Shore Hospital in Sydney Australia, gave two presentations in which he described the study methodology and overall results in the first, "Lessons from the SAFE study." In his second presentation, "Is albumin safe?" Dr. Finfer provided guidance for interpreting the data for clinical practice, in which he included discussion on the potential value of sub-group analysis.

Among the subgroups discussed, Dr. Finfer reported that patients with trauma and brain injury had a slightly lower risk of death when treated with saline, while patients with severe sepsis seemed to benefit more from albumin. Dr. Finfer also noted that baseline albumin levels could be another factor to consider when choosing which fluid to use.

The SAFE study found no difference between saline and albumin in 28-day mortality among the critically ill. Dr. Finfer pointed out that the Cochrane study on albumin, a meta analysis of 24 studies, was flawed because the studies included looked at different types of patients and different drugs. The SAFE study, however, was strictly controlled and is already expected to be an exemplary study with the most reliable findings to date (though as yet - it is still unpublished) by many in the healthcare industry.

Further to this, in a separate pro/con debate "Colloids are better than crystalloids", both speakers, Monty G. Mythen from the UK and Joachim Boldt from Germany, unexpectedly presented two pro position presentations, highlighting the fact that there are differences between the molecules that could enhance the treatment effect in particular cases. Special properties of albumin, other than volume expansion capacity, appear to be important determinants of clinical benefit.

Albumin has unique properties such as it's ability to bind and transport drugs and other molecules. Calorie intake increases with albumin, while overall weight gain is reduced, compared to using crystalloids. In certain indications such as cardiac surgery and ascites, clear evidence indicates the cost-effectiveness of albumin. Ultimately, the choice to use either or both colloids and crystalloids depends on the best scientific data available, the clinical course of the patient, experience, and cost.

© Octapharma AG, 2004