Saturday, 08 August 2015 11:57

Anticoagulation news items. Week commencing 3rd August 2015

Use and Outcomes of Triple Therapy Among Older Patients With Acute Myocardial Infarction and Atrial Fibrillation

Journal of the American College of Cardiology

Analysis (n=4959) found that ~ 1 in 4 older AF patients undergoing PCI for MI were discharged on triple therapy; and those receiving triple therapy vs. dual antiplatelet therapy had higher rates of major bleeding without a measurable difference in composite MI, death, or stroke.

 

Optimizing the Safe Use of Direct Oral Anticoagulants in Older Patients: A Teachable Moment

JAMA Internal Medicine

Case of 86-year-old woman with AF who presents with persistent epistaxis and found to have supratherapeutic levels of rivaroxaban and creatinine clearance of 21 mL/min highlights challenge of ensuring appropriate and safe use of direct oral anticoagulants in frail older patients.

 

Recanalization Therapies in Acute Ischemic Stroke Patients: Impact of Prior Treatment with Novel Oral Anticoagulants on Bleeding Complications and Outcome - A Pilot Study

Circulation

The results of this observational study suggest IV thrombolysis or intra-arterial treatment in carefully selected patients with an ischaemic stroke who are taking NOACs may not be associated with an excessive risk of intracranial haemorrhage; further data are however required.

 

Oral dual antiplatelet therapy: what have we learnt from recent trials?

European Heart Journal

This paper outlines the evidence base for clinical decisions regarding timing of initiation and duration of dual antiplatelet therapy in acute coronary syndrome.

 

Pregnancy Complicated by Venous Thrombosis

New England Journal of Medicine

This clinical practice article starts with a case vignette of a pregnant women presenting with venous thrombosis. The author's recommendations are based on supporting evidence and guidelines.

 

Hemostatic efficacy, safety and pharmacokinetics of a recombinant von Willebrand factor in severe von Willebrand disease

Blood

In patients with severe type 1, 2, or 3 von Willebrand disease, a recombinant von Willebrand factor (initially administered together with recombinant Factor VIII) led to excellent or good control in 96.9% of 192 treated bleeds, with a single infusion effective in 81.8%.

 

Atrial fibrillation (non-valvular) - edoxaban tosylate [ID624]: final appraisal determination

National Institute for Health and Care Excellence

In DRAFT guidance (final appraisal determination), NICE recommends edoxaban, within its marketing authorisation, as an option for preventing stroke and systemic embolism in adults with non-valvular atrial fibrillation with one or more of the stated risk factors.

 

Venous thromboembolic diseases - management (Standing Committee B update): addendum consultation

National Institute for Health and Care Excellence

This DRAFT guideline update includes new recommendations on use of systemic thrombolysis in patients with 'intermediate-risk' pulmonary embolism, and on long-term use of compression stockings for the prevention of post-thrombotic syndrome in patients who have had a proximal DVT.

 

 

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