Items filtered by date: June 2019

Extended Anticoagulation for VTE: A Systematic Review and Meta-Analysis

Chest

Review of 16 studies (n=12,458) found DOACs linked to decrease in overall (risk ratio 0.48;95% CI;0.27-0.86;p=0.01) and VTE-related (0.36;0.15-0.89;p=0.03) mortality whereas VKAs were not. Both similarly prevented recurrent VTE but only VKAs linked to increased major bleeding risk.

 

Time Course for Benefit and Risk of Clopidogrel and Aspirin after Acute Transient Ischemic Attack and Minor Ischemic Stroke: A Secondary Analysis from the POINT Randomized Trial

Circulation

Secondary analysis of POINT (n=4,881) noted benefit of clopidogrel+aspirin occurs predominantly within first 21 days and outweighs low, but ongoing risk of major haemorrhage suggesting limiting use to 21 days may maximize benefit/reduce risk after TIA/minor ischaemic stroke.

 

Conference report: Increasing Dietary Vitamin K Intake Stabilizes Anticoagulation Therapy in Warfarin-Treated Patients with a History of Instability- A 24-week Randomized Controlled Trial

American Society for Nutrition

RCT (n=49) found increasing dietary vitamin K intakes resulted in greater proportion patients with %TTR ˃70% over assessment period. (50 % who increased intake by ≥150 µd/day through specific food choices met criteria vs. 19% control [general dietary information] group; p=0.026.

 

A systematic review of patient‐reported outcomes associated with the use of direct‐acting oral anticoagulants

British Journal of Clinical Pharmacology

Review of 21 studies reports patients appear to prefer treatment with DOACs vs warfarin, as shown by the higher quality of life, satisfaction and adherence described in the studies. However, heterogeneity in the analysed studies does not allow firm conclusions.

 

A comprehensive analysis of the effects of rivaroxaban on stroke or transient ischaemic attack in patients with heart failure, coronary artery disease, and sinus rhythm: the COMMANDER HF trial

European Heart Journal

In this post hoc analysis (n=5022), rivaroxaban significantly reduced the primary neurological endpoint of all-cause stroke or TIA compared with placebo by 32% (2.4% vs. 3.5%; 1.29 events vs. 1.90 events per 100 patient-years; HR 0.68; P = 0.02).

 

Effect of 1-Month Dual Antiplatelet Therapy Followed by Clopidogrel vs 12-Month Dual Antiplatelet Therapy on Cardiovascular and Bleeding Events in Patients Receiving PCI The STOPDAPT-2 Randomized Clinical Trial

Journal of the American Medical Association

This RCT (n=2974) reports 1-month DAPT was both noninferior and superior to 12-month DAPT for the primary end point, occurring in 2.36% with 1-month DAPT v 3.70% with 12-month DAPT (difference −1.34%; HR 0.64, meeting criteria for noninferiority (P<0.001) and superiority (P=0.04).

 

Effect of P2Y12 Inhibitor Monotherapy vs Dual Antiplatelet Therapy on Cardiovascular Events in Patients Undergoing Percutaneous Coronary Intervention The SMART-CHOICE Randomized Clinical Trial

Journal of the American Medical Association

In this RCT (n=2912) P2Y12 inhibitor monotherapy after 3-month duration of DAPT resulted in a noninferior rate of major cardiovascular events (all-cause death, MI, and stroke) vs prolonged DAPT at 12 months (2.9% vs 2.5%; difference 0.4%; P=0.007 for non-inferiority).

 

Revised SPC: Xarelto (rivaroxaban) film-coated tablets

electronic Medicines compendium

The SPC has been updated in line with PRAC recommendations to advise DOACs, including rivaroxaban, are not recommended for patients with a history of thrombosis who are diagnosed with antiphospholipid syndrome, in particular for patients that are triple positive.

 

Coagulation Testing in Patients Taking Direct Oral Anticoagulants: A Teachable Moment

JAMA Internal Medicine

This Teachable Moment examines the case of a man taking a direct oral anticoagulant (DOAC) who received a high INR test result during a visit to the emergency department, and highlights that INR is an unreliable measure of therapeutic anticoagulation in patients taking DOACs.

 

 

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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Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome

Medicines and Healthcare products Regulatory Agency

MHRA advises that DOACs are not recommended in patients with antiphospholipid syndrome, particularly high-risk patients (those who test positive for all 3 antiphospholipid tests — lupus anticoagulant, anticardiolipin antibodies, and anti-beta 2 glycoprotein I antibodies).

 

Safety and Efficacy of Antithrombotic Strategies in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Network Meta-analysis of Randomized Controlled Trials

JAMA Cardiology

Review of 4 RCTs (n = 10 026) found DOAC plus P2Y12 inhibitor was linked to less bleeding vs. vitamin K antagonists + dual antiplatelets; strategies omitting aspirin caused less bleeding without significant difference in major adverse CV event vs. strategies including aspirin.

 

Warfarin dose requirement in patients having severe thrombosis or thrombophilia

British Journal of Clinical Pharmacology

Study (n=50) found that currently the most used pharmacogenetics dosing algorithms (IWPC and Gage) underestimate the warfarin dose required for effective anticoagulation in thrombogenic young (age <50 years) patients, particularly those who are at the highest thrombotic risk.

 

Revised SPC: Brilique (ticagrelor) tablets

electronic Medicines compendium

Thrombotic thrombocytopenic purpura has been added as a potential adverse effect of treatment (frequency unknown).

 

Ticagrelor Versus Clopidogrel in Patients With STEMI Treated With Fibrinolysis: TREAT Trial

Journal of the American College of Cardiology

Open-label RCT (n=3,799) found that ticagrelor did not significantly reduce the frequency of CV events vs clopidogrel when used after fibrinolytic therapy (combined outcome of CV mortality, MI or stroke = 6.7% vs 7.3% for ticagrelor vs clopidogrel, HR 0.93, 95% CI 0.73-1.18).

 

Oral anticoagulants in atrial fibrillation with valvular heart disease and bioprosthetic heart valves

European Heart Journal

Network meta-analysis (n=13,574) found that NOACs are superior, vs warfarin, in reducing stroke or systemic embolisation, MI and intracranial haemorrhage in AF and valvular heart disease. Analysis of 280 patients with AF and bioprosthetic heart valve showed similar outcomes.

 

 

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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Revised SPCs: Eliquis (apixaban) film-coated tablets- all strengths

electronic Medicines compendium

SPCs highlight DOACs are not recommended for patients with history of thrombosis diagnosed with antiphospholipid syndrome, in particular, triple positive patients, where use of DOACs could be associated with increased rates of recurrent thrombotic events vs. vitamin K antagonists.

 

 

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

Rivaroxaban With or Without Aspirin in Patients with Heart Failure and Chronic Coronary or Peripheral Artery Disease: The COMPASS Trial

Circulation

Analysis of data from the COMPASS RCT (n=27,395) found that in heart failure patients specifically (5,902 patients), rivaroxaban plus aspirin was similarly superior to aspirin alone as per the overall trial population.

 

Evaluation of the Incidence of New-Onset Atrial Fibrillation After Aortic Valve Replacement

JAMA Internal Medicine

This population-based study reports new-onset AF was present in 50% of hospitalisations for transcatheter aortic valve implantation and aortic valve replacement. It advises shared patient-doctor decision making regarding potential need for anticoagulation after these procedures.

 

 

 

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