Rivaroxaban Versus Vitamin K Antagonist in Antiphospholipid Syndrome: A Randomized Noninferiority Trial

Annals of Internal Medicine

In this RCT of 190 APS patients, after 3years of follow-up, recurrent thrombosis occurred in 11 patients (11.6%) in the rivaroxaban group and 6 (6.3%) in the VKA group (RR in the rivaroxaban group, 1.83 [95% CI, 0.71 to 4.76] prespecified noninferiority margin for RR was 1.40).

Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial

The Lancet

RCT of 9202 patients treated within 3hrs of injury reports lower risk of head injury-related death at 28days with tranexamic acid (18.5%) vs placebo (19.8%; RR 0.94 [95% CI 0.86–1.02]), and this was statistically significant in those with mild-moderate injury (RR 0.78, 0.64–0.95).

US FDA approves rivaroxaban (Xarelto) for the prevention of venous thromboembolism in acute medical patients

Biospace Inc.

Approval is based on data from the phase III MAGELLAN and MARINER trials. MAGELLAN met its co-primary endpoints, demonstrating non-inferiority to enoxaparin in short-term (10 days) and superiority in long-term (35 days) use, while MARINER demonstrated reduction in symptomatic VTE.

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

NIHR Signal: Short-term dual antiplatelet treatment may be best for most patients after receiving a drug-eluting stent

National Institute for Health Research

Expert commentary is provided on a network meta-analysis (17 RCTs, n= 46,864) which showed standard 12-month treatment increased the risk of any bleeding compared with 6 month short-term treatment (OR 1.39, 95% CI 1.01 to 1.92).

Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study

Heart

Study (n=36,652) found adherence & persistence to direct oral anticoagulants are low at 1 yr with heterogeneity across drugs and over time at individual and system levels. Authors state better understanding of contributory factors will inform interventions to improve adherence.

Antithrombotic treatment after coronary artery bypass graft surgery: systematic review and network meta-analysis

British Medical Journal

Analysis (20 RCTs;n=4083) found moderate evidence to support dual antiplatelet use [aspirin(AS)+ticagrelor; OR 0.50,95% CI 0.31-0.79, NNT 10 or AS+clopidogrel; 0.60;0.42-0.86, 19] to reduce saphenous vein graft failure vs aspirin, with no significant differences in major bleeding.

Comparison of Events Across Bleeding Scales in the ENGAGE AF-TIMI 48 Trial

Circulation

In this study of edoxaban vs warfarin (n=21,105; and 10,311 total bleeding events), there was ~4-fold difference in frequency of most severe bleeding events across commonly used bleeding scales (ISTH, TIMI, GUSTO, and BARC) among patients with AF at risk for stroke.

Long-term Thromboembolic Risk in Patients With Postoperative Atrial Fibrillation After Left-Sided Heart Valve Surgery

JAMA Cardiology

Study found new-onset post op AF (POAF) was linked to a similar long-term risk of thromboembolism as nonvalvular AF (crude incidence rates 21.9 and 17.7 events/1000 person-years respectively), highlighting need for further studies addressing anticoagulation in POAF population.

Revised SPC: Plavix (clopidogrel) tablets

electronic Medicines compendium

SPC now details that co-administration of opioids has the potential to delay and reduce the absorption of clopidogrel due to delayed gastric emptying. The use of parenteral antiplatelet agent in ACS should be considered where opioid co-administration is required.

Direct oral anticoagulant for the prevention of thrombosis in ambulatory patients with cancer: A systematic review and meta-analysis

Journal of Thrombosis and Haemastasis

Review of 28 studies reports that low‐dose direct oral anticoagulant prophylaxis reduces the rate of overall venous thromboembolism in high‐risk cancer patients starting systemic chemotherapy but may increase the risk of bleeding.

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

Association of General Anesthesia vs Procedural Sedation With Functional Outcome Among Patients With Acute Ischemic Stroke Undergoing Thrombectomy: A Systematic Review and Meta-analysis

Journal of the American Medical Association

Review of 3 RCTs (n=368) found that protocol-based general anaesthesia was associated with less disability at 3 months vs procedural sedation (difference = +0.43 on modified Rankin Scale score, OR 1.58, 95% CI 1.09-2.29).

Compression stockings to prevent post-thrombotic syndrome in adults, a Bayesian meta-analysis

Thrombosis Reasearch

Review of 4 studies found that compression stockings reduced post thrombotic syndrome (PTS) vs. control in acute DVT, but that the difference was not statistically significant (OR = 0.57, 95% CI: 0.21-1.20).

Very Short Dual Antiplatelet Therapy after Drug-eluting Stent Implantation in Patients with High Bleeding Risk: Insight from the STOPDAPT-2 Trial

Circulation

Japanese RCT (n=3,009) found 1-month therapy reduced major bleeding vs. 12-months (0.41% vs. 2.71%, HR 0.15, 95% CI 0.03-0.65, p=0.01); without any increase in CV events (3.48% vs. 5.98%, absolute difference -2.50%, 95% CI -5.06% to 0.06%, HR 0.57, 95% CI 0.32-1.03, p=0.06).

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