Friday, 28 September 2018 19:01

Anticoagulation news items. Week commencing 24th September 2018

Continuation versus discontinuation of antiplatelet therapy for bleeding and ischaemic events in adults undergoing non‐cardiac surgery

Cochrane Database of Systematic Reviews

Review of 5 RCTs (n=666) found low‐certainty evidence that either continuation or discontinuation of antiplatelet therapy before non‐cardiac surgery may make little or no difference to mortality, bleeding requiring surgical intervention, or ischaemic events.

 

Healthcare professional letter: Actilyse (Alteplase) in Acute lschaemic Stroke: Important information on extension to use in adolescents and request for data collection

Boehringer Ingelheim

Following the recent license extension of Actilyse® (alteplase) to include adolescents of 16-17 years in the acute ischaemic stroke indication, Boehringer Ingelheim is requesting collection of further data on safety and efficacy in this population.

 

A systematic review of clinicians' views and experiences of direct‐acting oral anticoagulants in the management of nonvalvular atrial fibrillation

British Journal of Clinical Pharmacology

Review of 10 studies notes in studies reporting clinician preference, DOACs were 1st choice over warfarin in naïve patients based on perceptions of evidence of effectiveness equivalent/superior to warfarin and superior safety. There were concerns about managing over-anticoagulation.

 

Effect of Variation in Published Stroke Rates on the Net Clinical Benefit of Anticoagulation for Atrial Fibrillation

Annals of Internal Medicine

Markov model decision analysis (n=33,434) with warfarin as base case, and DOACs modeled in secondary analysis found variation in published AF stroke rates for patients not on anticoagulants results in multifold variation in net clinical benefit of anticoagulation.

 

An Open-Label Randomized Trial Comparing Oral Anticoagulation with and without Single Antiplatelet Therapy in Patients with Atrial Fibrillation and Stable Coronary Artery Disease Beyond One Year after Coronary Stent Implantation: The OAC-ALONE Study

Circulation

RCT prematurely terminated after enrolling 696 patients in 38 months did not establish non-inferiority of oral anticoagulation (OAC) alone to combined OAC and antiplatelet therapy in patients with AF and stable coronary artery disease beyond 1 year after stenting.

 

Improved Stroke Prevention in Atrial Fibrillation After the Introduction of Non–Vitamin K Antagonist Oral Anticoagulants

Stroke

Analysis of pharmacy claims data found increased oral anticoagulant use (from 51.6% to 73.8%) contributed to marked reduction of ischaemic strokes (2.01/100 person-years in 2012 to 1.17 in 2017; incidence rate ratio, 0.58; 95% CI, 0.52–0.65) without increasing bleeding rates.

 

Non–Vitamin K Antagonist Oral Anticoagulants for Mechanical Heart Valves: Is the Door Still Open?

Circulation

Mechanical valves currently pose absolute contraindication to DOACs based on results of single phase II study (RE-ALIGN). Article calls on several aspects of both preclinical studies and RE-ALIGN to be critically re-evaluated to identify patients most likely to benefit from DOACs.

 

AF screening: who is calling the tune?

Drug and Therapeutics Bulletin

Editorial highlights need to recognise gaps in evidence for population screening (PS), uncertainty over harm:benefit ratio of anticoagulation in people at lower risk, impact of labelling people with AF diagnosis, and guard against industry-led incremental drift to widespread PS.

 

Vorapaxar for HIV-associated inflammation and coagulopathy (ADVICE): a randomised, double-blind, placebo-controlled trial

The Lancet

This RCT (n=65) demonstrated that vorapaxar, a licensed inhibitor of proteinase activated receptor-1, had no effect on D-dimer concentrations in HIV-infected patients receiving stable antiretroviral therapy but at risk of poor outcomes.

 

Antifibrinolytic therapy for preventing oral bleeding in people on anticoagulants undergoing minor oral surgery or dental extractions

Cochrane Database of Systematic Reviews

There were no eligible trials in people on continuous DOAC treatment. For vitamin K antagonists (4 studies; n=253) there seems to be a beneficial effect of locally applied tranexamic acid; however definitive conclusions cannot be made due to limitations of the evidence.

 

 

The above records have been identified by UKMi and feature in the NICE Medicines Awareness Service. Further details on this service can be found at:

http://www.evidence.nhs.uk/about-evidence-services/content-and-sources/medicines-information/new-medicines-awareness-services