Revised SPC: Plavix (clopidogrel) 300 mg film-coated tablets
electronic Medicines compendium
SPC have been updated with licence extension for use in combination with aspirin in adult patients with moderate to high-risk transient ischaemic attack (ABCD2-[1] score ≥4) or minor ischaemic stroke (NIHSS-[2] ≤3) within 24 hours of an event.
Comparative effectiveness of oral anticoagulants in everyday practice
Heart
Registry study (n=25,551) found DOACs were associated with a lower risk of all-cause mortality vs VKAs (3.6 vs 4.8 per 100 patient years, HR 0.79, 95%CI 0.70-0.89) and major bleeding (1.0 vs 1.4, 0.77, 0.61-0.98) with similar risk of non-haemorrhagic stroke or systemic embolism.
Circulation
Review of this study found that although pretreatment endogenous factor Xa activity was significantly higher in women than in men, treatment with edoxaban resulted in eventual similar endogenous factor Xa activity, and the efficacy profile was similar between sexes.
Thombosis Research
Review (18 studies) findings do not support use of prediction models to weigh risks for recurrence and bleeding when deciding to anticoagulated patients after initial treatment of VTE. Important methodological limitations and insufficient predictive accuracy were found.
Direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic review
BMJ Open
Review of 33 studies (1 RCT, 5 observational cohorts and 27 case series, total n=594) concludes that the evidence for DOACs in cerebral venous thrombosis is limited, but suggests sufficient safety and efficacy vs standard therapy. Further rigorous trials are needed.
Prophylactic anticoagulation for patients in hospital with covid-19
British Medical Journal
This editorial discusses research to date on thromboprophylaxis in patients admitted to hospital with Covid-19 including the interim results from three separate RCTs (anticoagulation arm of REMAP-CAP, ATTACC, and ACTIV4a), widely available before peer-review.
Primary prophylaxis for venous thromboembolism in ambulatory cancer patients receiving chemotherapy
Cochrane Database of Systematic Reviews
This updated review (32 RCTs [6 new]; n=15,678) found LMWH reduce, and direct factor Xa inhibitors may reduce, incidence of symptomatic VTE; both likely increase risk of major bleeding. Evidence for use of thromboprophylaxis with other anticoagulants is limited.
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
