Pregnancy, thrombophilia, and the risk of a first venous thrombosis: systematic review and bayesian meta-analysis

British Medical Journal

This review of 36 cohort or case-control studies (41,297 reported pregnancies) found all inherited thrombophilias increased the risk for pregnancy associated VTE, with the highest risks seen for antithrombin, protein C and protein S deficiency, and homozygous factor V Leiden.

Less dementia with oral anticoagulation in atrial fibrillation

European Heart Journal

Swedish retrospective registry study (n=444,106) found anticoagulant treatment at baseline was associated with 29% lower risk of dementia than in patients not on anticoagulant [HR 0.71, 95% CI, 0.68–0.74]. Direct comparison between DOACs and warfarin showed no difference.

Streamlining primary and secondary care management pathways for stroke prevention in atrial fibrillation

European Heart Journal

This article outlines the collaborative working between primary and secondary care in one CCG in the development of a simple and practical decision-making pathway for stroke prevention in atrial fibrillation.

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

Safety and efficacy of long-term treatment of chronic/persistent ITP with eltrombopag: final results of the EXTEND study

Blood

Over median duration of 2.37 years, 259 patients (85.8%) achieved response (platelets ≥50×109/L at least once in absence of rescue) and 133 of 257 (52%) achieved continuous response ≥25 weeks. Rate of thromboembolic events (6%) did not increase with treatment duration past 1 year.

Comparative safety of direct oral anticoagulants and warfarin in venous thromboembolism: multicentre, population based, observational study

British Medical Journal

Retrospective study (n=12,489 on DOACs and 47,036 on warfarin in Canada and US with new diagnosis of venous thromboembolism) found treatment with DOACs, compared with warfarin, was not linked to increased risk of major bleeding or all-cause mortality in first 90 days of treatment.

Co-administration of cyclosporine and ticagrelor may lead to a higher exposure to cyclosporine: a case report of a 49-year-old man

British Journal of Clinical Pharmacology

Timeline for increase in trough level of cyclosporine after introduction of ticagrelor (TC) for unstable angina was considered consistent with appearance of an interaction, thought to be due to inhibition of CYP3A4 and P-glycoprotein by TC, which was managed by cessation of TC.

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

Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism (Update): Draft guidance consultation

National Institute for Health and Care Excellence

A DRAFT update of NICE guideline CG92 (published January 2010), which includes new and updated recommendations on the risk assessment and prophylaxis of people at risk of venous thromboembolism, is now available for consultation.

Bayer halts Phase III study of rivaroxaban in embolic stroke

PharmaTimes

Bayer has halted a Phase III study investigating rivaroxaban in patients with embolic stroke of undetermined source after it showed no improvements in efficacy when compared to aspirin. Bleeding rates were low overall but higher in the rivaroxaban arm (no data presented).

In Use Product Safety Assessment report for Inhixa (enoxaparin biosimilar)

Specialist Pharmacy Service

This assessment, produced using the validated UKMi product assessment tool, discusses practical safety considerations associated with the introduction of this biosimilar product, including the need to ensure prescribing of product by brand name.

Anticoagulation combined with antiplatelet therapy in patients with left ventricular thrombus after first acute myocardial infarction

European Heart Journal

Review (n=1850 with MI) found that among those with a left ventricular thrombus given a vitamin K antagonist, those with a time in therapeutic range (TTR) ≥50% had a lower risk of thromboembolism vs those with TTR <50% (2.9% vs 19%, p=0.036) with no difference in major bleeding.

Indications for anticoagulant and antiplatelet combined therapy

British Medical Journal

Review notes combination treatment increases risk of bleeding, and this risk should be estimated and discussed with patients to guide treatment decisions (e.g. using risk scores such as HAS-BLED). Consideration should be given to addition of H2 antagonist or proton pump inhibitor.

Association Between Use of Antithrombotic Medication and Hematuria-Related Complications

Journal of the American Medical Association

Canadian retrospective cohort study (n=808,897) found that over a median follow-up of 7.3 years the rate of haematuria complications was higher in those exposed to antithrombotics vs those not exposed (123.95 vs 80.17 per 1000 person years, Rate Ratio 1.44, 95% CI 1.42-1.46).

Association Between Use of Non–Vitamin K Oral Anticoagulants With and Without Concurrent Medications and Risk of Major Bleeding in Nonvalvular Atrial Fibrillation

Journal of the American Medical Association

Taiwanese study (91,330 patients on NOACs) found that those on concurrent amiodarone, fluconazole, rifampicin and phenytoin had a significant increased risk of major bleeding vs NOAC use alone (difference +13.94, +138.46 +36.90 and +52.31 incidents per 1000 person years).

Clinical impact of major bleeding in patients with venous thromboembolism treated with factor Xa inhibitors or vitamin K antagonists

Thrombosis and Haemostasis

Combined data from the EINSTEIN, AMPLIFY and HOKUSAI-VTE studies found that factor Xa inhibitor associated major bleeding events in these studies had a less severe presentation and similar course compared to vitamin K antagonists.

Shortage of abciximab (Reopro) 2mg/ml solution for injection or infusion

Specialist Pharmacy Service

There is a potential 6 month supply issue affecting abciximab from October through till March 2018. This memo advises on alternative treatment options in the interim should stock run out.

Low-Dose vs Standard-Dose Alteplase for Patients With Acute Ischemic Stroke: Secondary Analysis of the ENCHANTED Randomized Clinical Trial

JAMA Internal Medicine

This secondary analysis of a RCT that involved 3310 patients with acute ischaemic stroke found no clear differential benefits of low-dose alteplase compared with standard-dose alteplase in disability outcomes, irrespective of age, race/ethnicity, and neurological severity.

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