Items filtered by date: September 2021

Novel bleeding prediction model in atrial fibrillation patients on new oral anticoagulants

Heart
Article describes development of a risk score including 9 variables (e.g. male sex, anaemia, thrombocytopaenia, concurrent antiplatelet therapy, hypertension, prior major bleeding, risk factors for a fall, low cholesterol level and low eGFR), requiring further validation.

 

 

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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Long-term risk for major bleeding during extended oral anticoagulant therapy for first unprovoked venous thromboembolism: A Systematic Review and Meta-analysis

Annals of Internal Medicine
Review (14 RCTs;13 cohort studies; n=17,202) found long-term risks & consequences of anticoagulant-related major bleeding are considerable in this population (incidence/100 person-years =1.74 events with VKAs & 1.12 events with DOACs;5-year cumulative incidence with VKAs was 6.3%.

 

Utilization and long-term persistence of direct oral anticoagulants among patients with nonvalvular atrial fibrillation and liver disease

British Journal of Clinical Pharmacology
UK study (n=3167; 71% on DOACs; 29% vitamin K antagonists [VKA]) found initiators of DOACs were more likely to have prior ischemic stroke (OR 1.44), less likely to have used antiplatelets (OR 0.66) and more likely to persist with treatment at 5 years vs VKAs (31% vs 9%).

 

 

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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Effects of Antiplatelet Therapy After Stroke Caused by Intracerebral Hemorrhage: Extended Follow-up of the RESTART Randomized Clinical Trial

JAMA Neurology
UK RCT (n=537; median 3-year follow-up), found no difference in recurrent intracerebral haemorrhage (8.2% with antiplatelet therapy [AT] vs 9.3% without AT; adjusted HR, 0.87; 95% CI, 0.49-1.55; P = 0.64) or major vascular events (26.8 vs 32.5%; 0.79; 0.58-1.08; P = 0.14).

 

Effects of oral anticoagulation for atrial fibrillation after spontaneous intracranial haemorrhage in the UK: a randomised, open-label, assessor-masked, pilot-phase, non-inferiority trial

The Lancet Neurology
SoSTART RCT (n=218) did not confirm non-inferiority of starting oral anticoagulation (OAC) vs avoiding OAC for recurrent intracranial haemorrhage: 8% vs 4%; adjusted HR 2.42; 95% CI 0.72–8.09; p=0.152) with no difference in serious adverse events (17% vs 15%).

 

De-Escalation of Dual Antiplatelet Therapy in Patients WithAcute Coronary Syndromes

Journal of the American College of Cardiology
In analysis (15 RCTs;n=55,798), DAPT with aspirin & de-escalation from standard-dose potent P2Y12inhibitor (ticagrelor or prasugrel[PG]) to clopidogrel or low-dose PG 1 month after PCI was linked to fewer bleeding events vs. other DAPT strategies & no increase in ischaemic events.

 

Utility of Intravenous Alteplase Prior to Endovascular Stroke Treatment: A Systematic Review and Meta-analysis of RCTs

Neurology
Review (3 studies, n=1092) detected no differences in functional outcomes at 3 months with direct endovascular treatment compared to combination of endovascular treatment preceded by IV thrombolysis in patients with an acute large vessel occlusion.

 

 

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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Thrombolytic therapy for pulmonary embolism

Cochrane Database of Systematic Reviews
Review (21 RCTs [3 new]; n=2401) found low‐certainty evidence suggesting thrombolytics may reduce death following acute PE compared with heparin and may be helpful in reducing the recurrence of pulmonary emboli, but may cause more major and minor haemorrhagic events.

 

Dual Antiplatelet Therapy after PCI in Patients at High Bleeding Risk

New England Journal of Medicine
In people at high risk of bleeding after implantation of drug-eluting stent (n=4434), 1 month of dual antiplatelet therapy was non-inferior to continuation for ≥2 additional months with regard to occurrence of net adverse clinical events and major adverse cardiac/cerebral events.

 

Edoxaban versus Vitamin K Antagonist for Atrial Fibrillation after TAVR

New England Journal of Medicine
In this study (n=1426), edoxaban was non-inferior to vitamin K antagonists in terms of the primary composite endpoint (death, MI, ischaemic stroke, systemic thromboembolism, valve thrombosis, major bleeding) in people with AF after successful TAVR (HR 1.05; 95% 0.85-1.31; p=0.01).

 

2021 European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guidelines for the management of valvular heart disease

European Heart Journal
This updated guideline considers new evidence in this area, leading to a number of new recommendations, including use of anti-thrombotic therapies in patients with surgical or transcatheter bioprostheses for bridging during perioperative periods and over the long term.

 

 

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