Anticoagulation news items. Weeks commencing 21st February 2022
Anticoagulation for the initial treatment of venous thromboembolism in people with cancer
Cochrane Database of Systematic Reviews
Updated review including 15 RCTs (n=1615) found low molecular weight heparin is probably superior to unfractionated heparin for initial VTE treatment in cancer. Additional trials focusing on patient‐important outcomes will further inform the questions addressed in this review.
Prevalence and management of drug interactions between NSAID and antithrombotics in ambulatory care
British Journal of Clinical Pharmacology
This article discusses a prospective intervention study of 782 interactions from an older, polymedicated patient population. It found anticoagulants were involved in 16.1% of the cases and for 61% of all cases, the interacting drugs were prescribed by the same physician.
British Journal of General Practice
Anticoagulation (AC) treatment vs no AC was linked to significantly lower all-cause mortality & risk of non-haemorrhagic stroke/ systemic embolism (aHR 0.70; 95% CI 0.53 to 0.93 & 0.39; 95% CI 0.24-0.62) and a non-significant higher risk of major bleeding (1.31;95% CI 0.77-2.24).
BMJ Open
Review (10 RCTs; n=37,298) found no significant differences in efficacy of DOACs among the three creatinine clearance subgroups, for acute or extended treatment of VTE. Aapixaban may be associated with lower bleeding risk in CrCl >80 mL/min subgroup; confirmation is needed.
Cochrane Database of Systematic Reviews
Review (34 studies; n=14,931) found combining intermittent pneumatic leg compression (IPC) with pharmacological prophylaxis (PP) reduces incidence of PE & DVT vs. IPC alone (low‐certainty evidence [LCE]). Compared to PP alone, it also reduces incidence of PE(LCE) & DVT (high‐CE).
Oral antiplatelet therapy for acute ischaemic stroke
Cochrane Database of Systematic Reviews
Updated review (11 studies, n=42,226) found antiplatelet therapy with aspirin 160-300 mg daily started within 48 hours significantly decreased death & dependency, and reduced risk of early recurrent stroke without a major risk of early haemorrhagic complications.
National Institute for Health Research
Analysis of responses to survey from 181 NHS adult general ICUs in England, Wales (n=69,001) found change to regional citrate anticoagulation was not linked to step change in 90-day mortality (OR 0.98, 95% CI 0.89 to 1.08) and is likely to have substantially increased costs.
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
Anticoagulation news items. Weeks commencing 14th February 2022
Triple antithrombotic therapy and dual therapy – What is the evidence base?
British Journal of Clinical Pharmacology
Triple antithrombotic therapy refers to concurrent use of oral anticoagulant in combination with dual antiplatelet therapy. Review makes recommendations on duration, noting recommendations in guidelines will remain in flux until there is conclusive evidence about when to step down.
British Journal of General Practice
Among 52,832 current oral anticoagulant (OAC) users and 18,271 non-users with low baseline stroke risk (CHA₂DS₂-VASc score 2), those on OACs had a lower risk of testing positive for SARS-CoV-2 (aHR, 0.77, 95%CI, 0.63–0.95) and severe COVID-19 outcomes than non-users.
Intravenous thrombolytic treatment and endovascular thrombectomy for ischaemic wake‐up stroke
Cochrane Database of Systematic Reviews
Review of 7 trials (n=980) found both IV thrombolysis and endovascular thrombectomy of large vessel occlusion improved functional outcome without increasing risk of death, but, a possible increased risk of symptomatic intracranial haemorrhage with thrombolysis cannot be ruled out.
European Journal of Vascular and Endovascular Surgery
Review (7 RCTs) found ultrasound assisted catheter directed thrombolysis may improve patency rates vs the other treatment modalities. However, no treatment modality showed superiority in reduction of post-thrombotic syndrome and overall quality of available evidence was poor.
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
Anticoagulation news items. Weeks commencing 7th February 2022
British Journal of Clinical Pharmacology
Review (15 studies) found in AF patients treated with NOACs, concomitant use of P-gp/CYP3A4 inhibitors was associated with higher risk of major bleeding (RR 1.10, 95% CI 1.01-1.19) and all-cause mortality (1.14, 95% CI 1.05-1.23); authors recommend close monitoring.
The Lancet Haematology
Study of 118,952 admissions to 31 neonatal intensive care units found bloodstream infection (OR 2.07), maternal diabetes (1.62), abdominal surgery (1.36) and thrombocytopenia (2.44) were the most significant risk factors for venous thrombosis (p<0.0001 for all).
Revised SPC: Clexane (enoxaparin)- all presentations
electronic Medicines compendium
SPC updated to warn acute generalised exanthematous pustulosis reported (unknown frequency); patients should be advised of signs/symptoms & monitored for skin reactions, enoxaparin should be withdrawn immediately & alternative treatment considered (as appropriate), if this occurs.
Journal of the American Medical Association
Retrospective study (n=163,038) found NOAC use within past 7 days was not associated with increased risk of intracranial haemorrhage among patients with acute ischaemic stroke treated with alteplase (3.7% vs 3.2% in those not taking NOACs; adjusted OR 0.88 [95% CI 0.70 to 1.10]).
Journal of the American Medical Association
Phase 2b trial (n=121) found use of intra-arterial alteplase following thrombectomy resulted in a greater likelihood of excellent neurological outcome (modified Rankin Scale score of 0 or 1) than placebo at 90 days (59.0% vs 40.4%; P=0.047); these findings require confirmation.
Biospace Inc.
Asundexian is an oral inhibitor of Factor Eleven (FXIa) that is also being developed for atrial fibrillation and recent myocardial infarction. It is currently in Phase II clinical trials in all three conditions either as monotherapy or in combination with antiplatelets.
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
Anticoagulation news items. Weeks commencing 31st January 2022
British Journal of Clinical Pharmacology
Analysis (9 studies, n=994) found bivalirudin linked to lower risks of major bleeding (risk ratio 0.32;95% CI 0.22-0.49), ECMO in-circuit thrombosis (0.57;0.43-0.74), stroke (0.52;0.29-0.95), in-hospital mortality (0.82;0.69-0.99) & higher rates of survival to ECMO decannulation.
Anticoagulants for acute ischaemic stroke
Cochrane Database of Systematic Reviews
In updated review (28 trials [4 new];n=24,025), conclusions remain consistent, in that people who have early anticoagulation post acute ischaemic stroke do not show any net short‐ or long‐term benefit, with reduction in recurrent stroke, DVT & PE offset by increased bleeding risk.
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
