Friday, 05 October 2018 17:27

Anticoagulation news items. Week commencing 1st October 2018

Prevalence, Safety, and Effectiveness of Oral Anticoagulant Use in People with and without Dementia or Cognitive Impairment: A Systematic Review and Meta-Analysis

Journal of Alzheimer's Disease

Review of 27 trials found fewer people with dementia (DM) received oral anticoagulation (AC) vs. people without DM (32 v. 48%) but there was no difference in composite of embolic events/MI/all-cause death. People with DM had higher bleeding risk and poorer AC control on warfarin.

 

Antiplatelet and anticoagulant agents for primary prevention of thrombosis in individuals with antiphospholipid antibodies

Cochrane Database of Systematic Reviews

Review of 9 studies (n=1,044) found insufficient evidence to demonstrate benefit or harm of using anticoagulants with or without aspirin versus aspirin alone in people with antiphospholipid antibodies and a history of recurrent pregnancy loss and with no such history.

 

NIHR Signal: Two antiplatelet drugs may prevent further strokes but increase major bleeds

National Institute for Health Research Signal

Expert commentary is provided for an RCT which found that clopidogrel plus aspirin resulted in fewer ischaemic events, but more major bleeds vs aspirin. There may be a place for dual anti-platelets, but UK practice is clopidogrel monotherapy, and the comparator here was aspirin.

 

Six months versus 12 months dual antiplatelet therapy after drug-eluting stent implantation in ST-elevation myocardial infarction (DAPT-STEMI): randomised, multicentre, non-inferiority trial

British Medical Journal

RCT (n=870) found dual antiplatelet therapy (DAPT) to 6 months was non-inferior to DAPT for 12 months in patients with event-free STEMI at 6 months after primary PCI with second generation drug-eluting stents (HR 0.73, 95% CI, 0.41-1.27, p=0.26, and p=0.004 for non-inferiority).

 

Periprocedural Outcomes of Direct Oral Anticoagulants Versus Warfarin in Nonvalvular Atrial Fibrillation: Meta-Analysis of Phase III Trials

Circulation

Analysis of 4 substudies found no difference in stroke/systemic embolism, major bleeding, or death linked to procedures requiring temporary interruption of DOACs /warfarin (WF). For procedures using uninterrupted anticoagulation, DOACs had 38% lower risk of major bleeding vs. WF.

 

Anticoagulation for perioperative thromboprophylaxis in people with cancer

Cochrane Database of Systematic Reviews

Review (20 RCTs; n=9771) found no difference between perioperative thromboprophylaxis with low molecular weight heparin (LMWH) vs unfractionated heaparin and LMWH vs fondaparinux in their effects on mortality, thromboembolic outcomes, major bleeding, or minor bleeding.

 

Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial

The Lancet Haematology

Sub group analysis (n=534) found that rivaroxaban was associated with fewer recurrent stroke events than aspirin (4.8 versus 2.6 events/100 person-years) but this effect was not statistically significant.

 

Rivaroxaban vs warfarin in high-risk patients with antiphospholipid syndrome

Blood

This study comparing rivaroxaban and warfarin (target INR 2.5) in high-risk patients with thrombotic antiphospholipid syndrome was terminated prematurely (120 patients enrolled) due to an excess of events in the rivaroxaban group (19% v 3% with warfarin).

 

US FDA approves emicizumab (Hemlibra) to prevent or reduce frequency of bleeding episodes in patients with haemophilia A without factor VIII inhibitors

Biospace Inc.

Approval was based on data from the Phase III HAVEN 3 and HAVEN 4 trials, which showed it was associated with clinically meaningful reductions in treated bleeds compared to no prophylaxis. In the EU it is currently approved only for use in patients with factor VIII inhibitors.

 

 

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