Friday, 21 May 2021 17:44

Anticoagulation news items. Weeks commencing 17th May 2021

Systematic review of machine learning models for personalised dosing of heparin

British Journal of Clinical Pharmacology
Review concluded that there are limited studies of machine learning models for unfractionated heparin dosing, and none report a model ready for routine clinical use. Studies are low quality, inadequately report study factors and lack of external validation and impact analysis.

 

Total Ischemic Event Reduction with Rivaroxaban after Peripheral Arterial Revascularization in the VOYAGER PAD Trial

American Journal of Cardiology
Sub-analysis (n=6564) found rivaroxaban plus aspirin reduced total primary events (acute limb ischemia, major amputation, MI, ischemic stroke, or CV death; HR 0.86,95% CI 0.75-0.98; p=0.02) and peripheral revascularizations and VTE (0.86; 0.79-0.95; p=0.003) vs aspirin alone.

 

Single direct oral anticoagulant therapy in stable patients with atrial fibrillation beyond 1 year after coronary stent implantation

Heart
Korean study (n=4294; 94% with drug-eluting coronary stents) showed similar efficacy in preventing ischaemic events in the DOAC monotherapy vs DOAC plus antiplatelet group (HR 0.828, 95% CI 0.660 to 1.038) with lower risk of major bleeding (HR 0.690, 95% CI 0.481 to 0.989).

 

Sex Differences Among Patients With High Risk Receiving Ticagrelor With or Without Aspirin After Percutaneous Coronary Intervention: A Subgroup Analysis of the TWILIGHT Randomized Clinical Trial

JAMA Cardiology
Analysis (n= 7119) found women had a higher bleeding risk vs men, which was mostly attributable to baseline differences, whereas ischemic events were similar. Benefits of early aspirin withdrawal with continuation of ticagrelor were generally comparable in women and men.

 

Comparative Effectiveness of Aspirin Dosing in Cardiovascular Disease

New England Journal of Medicine
Open-label pragmatic trial found no differences in cardiovascular events (event rate 7.28% vs 7.51%; HR 1.02; 95% CI 0.91 to 1.14) or major bleeding (0.63% vs 0.60%; HR 1.18; 95% CI, 0.79 to 1.77) in patients with CVD assigned to 81 mg or 325 mg of aspirin daily, respectively.

 

Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM): an investigator-initiated, prospective, randomised, open-label, multicentre trial

The Lancet
Korean study found clopidogrel vs aspirin monotherapy significantly reduced composite of all-cause death, non-fatal MI, stroke, readmission due to acute coronary syndrome, and bleeding (n=5530; 24 month follow up; event rate 5.7% vs 7.7%; HR 0.73; 95% CI 0.59–0.90).

 

 

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