Friday, 26 March 2021 18:33

Anticoagulation news items. Week commencing 22nd March 2021

DTB select: DOAC drug interactions and risk of major bleeding

Drug and Therapeutics Bulletin
Summary and context are provided for a UK case–control study which found that use of antiplatelet drugs and SSRIs with DOACs was associated with an increased risk of major bleeds requiring hospital admission.

 

Warfarin dosing algorithms: A systematic review

British Journal of Clinical Pharmacology
Review (266 articles) found most algorithms have been developed in Asian and White populations and may not be applicable to under‐served populations. Few algorithms had been externally validated, assessed for clinical utility, and/or have a low risk of bias.

 

DTB select: Tranexamic acid should be avoided for acute gastrointestinal bleeds

Drug and Therapeutics Bulletin
Summary and context is provided on the HALT-IT trial which involved 12 000 people being treated for acute gastrointestinal bleeding, and found tranexamic acid had no effect on risk of death from bleeding but increased the risk of thromboembolism and seizures.

 

Association of risk factors and bleeding complications in Asian patients taking edoxaban

British Journal of Clinical Pharmacology
Trial (n=346) found weight ≤60 kg & presence of cancers could affect bleeding complications, which occurred despite proper edoxaban treatment in Asian patients. Authors suggest possibility of using more strict dosage guideline could be considered in patients of Asian ethnicities.

 

Aspirin versus anticoagulation in cervical artery dissection (TREAT-CAD): an open-label, randomised, non-inferiority trial

The Lancet Neurology
RCT (n=173 per protocol) did not show that aspirin was non-inferior to vitamin K antagonists (VKAs) in treatment of cervical artery dissection (primary endpoint in 21 [23%] of 91 patients on aspirin vs. 12 [15%] of 82 on VKA (absolute difference 8%, non-inferiority p=0.55).

 

P2Y12 inhibitor monotherapy after coronary stenting according to type of P2Y12 inhibitor

Heart
RCT (n=2993) found that 3-month dual antiplatelet therapy (DAPT) followed by clopidogrel monotherapy provided similar rates of a composite endpoint (all-cause death, myocardial infarction or stroke at 12 months) vs 12 months DAPT (3.0% for both, HR 1.02).

 

Incidence and predictors of stroke in patients with rheumatic heart disease

Heart
Cohort study (n=515) notes despite wide use of oral anticoagulants, stroke (SK) remains frequent in this population (1.47 SKs per 100 patient-years), with age, AF & prior SK predictors of long-term SK; more aggressive monitoring of anticoagulation may be warranted in recurrent SK.

 

Drug‐drug Interactions with Warfarin: A Systematic Review and Meta‐analysis

British Journal of Clinical Pharmacology
Analysis of 72 studies (11 RCTs; total n=3,735,775) found addition of antiplatelets (OR 1.74), antimicrobials (1.63), NSAIDs (1.83) SSRIs (1.62), mirtazapine (1.75) and loop diuretics (1.92) to warfarin was associated with increased risk of clinically relevant bleeding.

 

Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis

Thorax
Analysis (102 studies; n=64,503) found the frequency of COVID-19-related VTE was 14.7%; prevalence was higher in ICU (23.2% v 9.0%; P<0.0001). The frequency rate of overall arterial thromboembolic events was 3.9%; subgroup analyses failed to explain heterogeneity.

 

Antithrombotic therapy in diabetes: which, when, and for how long?

European Heart Journal
This review provides an up-to-date guide for antithrombotic management of individuals with diabetes mellitus and highlights gaps in knowledge that represent areas for future research, aiming to improve clinical outcome in this high-risk population.

 

HElping Alleviate the Longer-term consequences of COVID-19 (HEAL-COVID): national platform trial

HEAL-COVID
This study, which will enrol patients admitted to hospital with Covid-19 who are about to be discharged, will investigate whether apixaban (for 2 weeks) or atorvastatin (for 12 months) could prevent or reduce long-term outcomes for patients with Covid-19.

 

 

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