Items filtered by date: February 2019

Concomitant Use of Direct Oral Anticoagulants with Antiplatelet Agents and the Risk of Major Bleeding in Patients with Nonvalvular Atrial Fibrillation

American Journal of Medicine

Study (n=14,407) found during median 1.6 months follow-up, concomitant DOAC-antiplatelet (vs. Vit K antagonist-antiplatelet) linked to similar GI bleeding risk but decreased intracranial bleed risk (HR 0.46; 95% CI, 0.24-0.91) and other major bleeding (0.68; 95% CI, 0.51-0.91).

 

Turoctocog alfa pegol for Haemophilia A approved for use in the US

Biospace Inc.

Approval was on the basis of a trial which found that turoctocog alfa pegol provided effective prophylaxis and that patients were able to maintain a low median annualised bleeding rate of 1.18 on maintenance dosing. It is currently under regulatory review for use in the EU.

 

Adjunctive Intermittent Pneumatic Compression for Venous Thromboprophylaxis

New England Journal of Medicine

This RCT in which 2003 adults in ICU were randomised to either pharmacologic thromboprophylaxis alone or in combination with intermittent pneumatic compression, reports no statistically significant difference in incident proximal lower-limb DVT, or death from any cause at 90 days.

 

Efficacy and Safety of Apixaban versus Warfarin in Patients with Atrial Fibrillation and Extremes in Body Weight: Insights from the ARISTOTLE Trial

Circulation

Post-hoc analysis involving 1985 patients ≤60kg, 15,172 patients in the mid-range weight group and 982 patients >120kg reports treatment effect of apixaban vs warfarin for efficacy outcomes of stroke/systemic embolism, all-cause death, or MI was consistent across weight spectrum.

 

Intracerebral haemorrhage during alemtuzumab administration

The Lancet

In this letter, the authors describe the presentation of patients with intracerebral haemorrhage, and suggest that patients whose mean systolic BP increases >20mmHg (or 20% or more throughout the infusion period), might be at high risk of intracranial haemorrhage.

 

 

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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Pharmacist-led virtual clinics to optimise anticoagulation in AF

Public Health England

Over a 12-month period, the programme reviewed over 1500 patients with AF not receiving anticoagulation, which resulted in an additional 1,200 patients being anticoagulated. The 2 CCGs (Lambeth and Southwark) have since seen a 25% reduction in the rate of AF-related stroke.

 

 

 

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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Full Study Report of Andexanet Alfa for Bleeding Associated with Factor Xa Inhibitors

New England Journal of Medicine
Cohort study of 352 patients with acute major bleeding associated with the use of a factor Xa inhibitor, reported that andexanet reduced anti–factor Xa activity by 93% from baseline, and that 82% of patients achieved haemostatic efficacy at 12 hours.

 

Intensive blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke (ENCHANTED): an international, randomised, open-label, blinded-endpoint, phase 3 trial

The Lancet
RCT reported no change in functional status at 90 days with intensive (target systolic BP 130–140 mm Hg within 1 h) or guideline-recommended (target <180 mm Hg) BP lowering therapy over 72 h in 2227 alteplase-eligible patients with acute ischaemic stroke.

 

 

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