Items filtered by date: June 2017

Low-Molecular-Weight Heparin and the Relative Risk of Surgical Site Bleeding Complications: Results of a Systematic Review and Meta-Analysis of Randomized Controlled Trials of Venous Thromboprophylaxis in Patients After Total Joint Arthroplasty

Journal of Arthroplasty

Review of 45 RCTs (n= 56,730) found low-molecular-weight heparin had increased relative risk (RR) of surgical site bleeding vs. control (2.32; 95% CI, 1.40-3.85), warfarin (1.54; 1.23-1.94), and dabigatran (4.38; 1.53-12.57). There was trend towards increased risk vs. apixaban.

 

U.S. FDA grants priority review of rivaroxaban supplemental new drug application for 10 mg dose to reduce risk of recurrent venous thromboembolism (VTE)

Biospace Inc.

Application is for use of 10 mg once-daily dose to reduce risk of VTE after ≥6 months of standard anticoagulation and is based on data from EINSTEIN CHOICE study which found 2 doses of rivaroxaban (10 mg and 20 mg) to be superior to aspirin in reducing risk of recurrent VTE.

 

Risk for Major Bleeding in Patients Receiving Ticagrelor Compared with Aspirin After TIA or Acute Ischemic Stroke in the SOCRATES Study

Circulation

Review of the SOCRATES study found that bleeds occurred in 0.5% of patients on ticagrelor and 0.6% of patients on aspirin (HR 0.83 95% CI 0.52 to 1.34). Intracranial haemorrhage was reported in 0.2% of patients on ticagrelor and 0.3% on aspirin.

 

Benefits and Risks of Antithrombotic Therapy in Essential Thrombocythemia: A Systematic Review

Annals of Internal Medicine

No RCTs were identified. Review of 24 observational studies (n=6153) noted no extractable data on anticoagulants, lack of uniform bleeding definitions, and systematic reporting of outcomes, thus risk–benefit ratio of antiplatelets in essential thrombocythemia is highly uncertain.

 

Conference report- Assessing the risk-benefit of anticoagulants in elderly patients with cancer-associated venous thromboembolism: a population based study

Biospace Inc.

Population-based retrospective cohort study found use of anticoagulants in patients ≥65 years with cancer-related thrombosis results in higher mortality if they develop major bleeding (MB) compared to venous thromboembolic event [VTE] (7-day mortality rate:0.5% VTE vs. 11% MB).

 

Conference report: Emicizumab showed positive results in phase III studies (HAVEN 1 and HAVEN 2) in haemophilia A with inhibitors

Biospace Inc.

HAVEN 1 showed statistically significant reduction in bleed rate of 87% (risk rate 0.13, p<0.0001) with emicizumab prophylaxis vs. on-demand treatment with bypassing agents. HAVEN 2 study noted after 12 weeks, 1 of 19 children on emicizumab reported a treated bleed.

 

FDA approves betrixiban (BevyxXa) for preventing blood clots in hospitalised patients

PharmaTimes

The US approval was based on findings of the APEX Study (n=7513), which found that betrixiban reduced incidence of DVT and PE vs enoxaparin (4.4% vs 6.0%) with no significant increase in major bleeding (0.67% vs. 0.57%).

 

 

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

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Use of the Dual-Antiplatelet Therapy Score to Guide Treatment Duration After Percutaneous Coronary Intervention

Annals of Internal Medicine

Retrospective analysis of 1970 patients undergoing PCI reports prolonged dual-antiplatelet therapy (DAPT) resulted in harm in patients with low DAPT scores but reduced risk for ischaemic events in patients with high scores receiving paclitaxel-eluting stents.

 

Antithrombotic treatment after stroke due to intracerebral haemorrhage

Cochrane Database of Systematic Reviews

This review of two RCTs (n=121) concludes there is insufficient evidence to support or discourage the use of antithrombotic treatment after ICH. RCTs comparing starting vs avoiding antiplatelets /anticoagulants after ICH appear justified and are needed in clinical practice.

 

The role of contraindications in prescribing anticoagulants to patients with atrial fibrillation: a cross-sectional analysis of primary care data in the UK

British Journal of General Practice

Analysis (2004-2012) found presence/absence of recorded contraindications (CIs) has little influence on decision to prescribe anticoagulants (ACs) for prevention of stroke in AF patients. Nationally, 38,000 with AF and CIs were treated with ACs, which has safety implications.

 

It Is Time to End the Dualistic Short Versus Long Duration of Dual Antiplatelet Therapy Debates

Circulation

Viewpoint suggests it is time to end academic debate and begin clinical discussion, with a shift in focus away from dualistic short versus long duration thinking and towards discussions on which patients are best treated with short, standard or prolonged dual antiplatelet therapy.

 

Antiplatelet Therapy in Patients With Coronary Stents Undergoing Elective Noncardiac Surgery: Continue, Stop, or Something in Between?

Journal of the American Medical Association

Viewpoint notes that based on available, evidence, there is no clear link between antiplatelet strategy and rates of perioperative major adverse CV events and bleeding, even though physiological reasons would suggest that antiplatelet agents should be a factor in the risk of both.

 

Review: Indications and appropriate selection of novel oral anticoagulants in patients with atrial fibrillation

Heart

This review notes that in the absence of RCT evidence, patient-specific factors such as dosing preference (daily vs twice a day), renal function, liver function, gastrointestinal bleeding risks and drug–drug interactions can help guide treatment choice.

 

 

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

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Management of superficial venous thrombosis of the leg

Drug and Therapeutics Bulletin

Review notes lack of consensus on best treatment but oral NSAIDs and compression stockings are used to provide symptomatic relief for pain and swelling. Guidelines suggest that fondaparinux or a low molecular weight heparin are options for some high risk patients.

 

Reversal of trauma-induced coagulopathy using first-line coagulation factor concentrates or fresh frozen plasma (RETIC): a single-centre, parallel-group, open-label, randomised trial

The Lancet Haematology

RCT (n=100, Austria) was terminated early for futility and safety reasons because compared to patients on coagulation factor concentrates, a higher proportion of patients receiving fresh frozen plasma required rescue therapy (52 vs. 4%) and massive transfusion (30 vs. 12%).

 

Reversal strategies for non-vitamin K antagonist oral anticoagulants: a critical appraisal of available evidence and recommendations for clinical management—a joint position paper of the European Society of Cardiology Working Group

European Heart Journal

Paper notes that while available clinical data for specific antidotes of NOACs are limited, it is very likely these agents will successfully reverse.

 

Thrombophilia Testing in Provoked Venous Thromboembolism: A Teachable Moment

JAMA Internal Medicine

This Teachable Moment looks at the value of testing for inherited thrombophilia in patients with provoked venous thrombophilia.

 

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

 

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The treatment of paroxysmal atrial fibrillation in UK primary care

Heart

The proportion of patients with a CHADS2 score of ≥1 prescribed anticoagulants increased between 2000 and 2015. Although improved, use in those with paroxysmal AF remains lower in 2015 (56.2% versus 69.4% in patients with persistent/permanent AF, RR 0.76; 95% CI 0.74 to 0.77).

 

Diagnosis and management of deep vein thrombosis in pregnancy

British Medical Journal

The incidence of DVT among pregnant women is around 1.1 per 1000 deliveries. This article provides an update on the diagnosis and management of pregnant women with 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

Published in News