Anticoagulation news items. Week commencing 29th June 2020
European Journal of Hospital Pharmacy
Retrospective study (n=145) reported that INR target was reached in 102 patients, aPTT ratio target was reached in 113 patients, and 79 of 106 patients reversed for bleeding achieved haemostatic effectiveness after four-factor prothrombin complex concentrate (all p<0.0001).
Patterns of oral anticoagulation use with cardioversion in clinical practice
Heart
Analysis of AF registry data (n=13 004; 1613 met criteria) reported no differences in death (HR 1.19, 95% CI 0.62 -2.28, p=0.61), stroke/TIA (1.18; 0.30 -4.74; p=0.81) or major bleeding (1.29; 0.66 -2.52; p=0.45) at 1 year in patients treated with DOAC vs vitamin K antagonist.
Revised SPC: Tygacil (tigecycline) 50mg powder for solution for infusion
electronic Medicines compendium
Recommendation has been added regarding the need for monitoring of coagulation parameters, including blood fibrinogen, prior to and during tigecycline treatment; as well as a related update to frequency of existing side effect hypofibrinogenaemia from not known to rare.
Medicines and Healthcare products Regulatory Agency
Alert advises on need to remain vigilant, especially in patients with increased bleeding risks; and that specific reversal agents are available for dabigatran (Praxbind, [idarucizumab]), apixaban and rivaroxaban (Ondexxya [andexanet alfa]).
Circulation
RCT (n=122) reports cangrelor provided inferior inhibition of platelet aggregation (IPA) vs. tirofiban; both treatments yielded greater IPA vs. chewed prasugrel (which led to higher active metabolite concentration but not greater IPA compared with standard prasugrel tablet).
electronic Medicines compendium
This is new presentation, licensed for VTE treatment and medical and surgical prophylaxis, ACS, treatment of unstable angina & non ST-segment elevation myocardial infarction (NSTEMI), STEMI, and prevention of thrombus formation in extra corporeal circulation during haemodialysis.
The Lancet Haematology
Study (n=68) found coagulation activation is common in hospitalised patients with COVID-19, with elevated plasma von Willebrand factor levels increasing with disease severity. Findings identify a potential prognostic role for measurement of endothelial markers in this setting.
Revised SPCs: Pradaxa (dabigatran) hard capsules
electronic Medicines compendium
SPC updated to add 'neutropenia' and 'agranulocytosis' as adverse reactions (frequency not known).
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:
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Anticoagulation news items. Week commencing 22nd June 2020
National Institute for Health and Care Excellence
Avatrombopag is recommended as an option for treating severe thrombocytopenia (platelet count of <50,000/microlitre of blood) in adults with chronic liver disease having a planned invasive procedure.
Community pharmacy-based study of adherence to non-vitamin K antagonist oral anticoagulants
Heart
Belgian study (n=766) found a positive patient attitude towards DOAC therapy, with 21% reporting non-adherence according to the Medication Adherence Report Scale, and unintentional non-adherence being the most commonly reported reason (15.4%).
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:
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Anticoagulation news items. Week commencing 15th June 2020
Piperacillin/tazobactam-induced coagulopathy in a patient through a vitamin K-dependent mechanism
European Journal of Hospital Pharmacy
Case report describes 70-year-old female patient whose INR increased following piperacillin/tazobactam (PTZ). Coagulopathy was reversed with vitamin K, suggesting PTZ can induce coagulopathy through a vitamin K-dependent mechanism.
DTB Select: DOAC dose adjustment in renal impairment
Drug and Therapeutics Bulletin
Commentary and context are provided for a US registry-based study (n=6,682) which found that of the 4% of people treated with a DOAC who met the criteria for a dose reduction, only 20% of them had an appropriate dose adjustment.
Journal of the American Medical Association
RCT (n=3056) found composite endpoint of major bleeding and CV and cerebrovascular events was less frequent with ticagrelor monotherapy vs dual therapy with aspirin (3.9% vs 5.9%, HR 0.66, p=0.01) but lower than expected event rates should be considered when interpreting results.
The Lancet
This RCT in adults with severe GI bleeding (n=12,009) found no difference between tranexamic acid and placebo in death due to bleeding within 5 days (4% v 4%; RR 0.99; 95% CI 0.82-1.18) with a higher risk of VTE events (1.85; 95% CI 1.15-2.98) and seizures (1.73; 1.03-2.93).
Circulation
Meta-analysis of 5 RCTs (n=32,145) found discontinuation of aspirin therapy 1-3 months post PCI reduced major bleeding risk vs continued dual antiplatelet therapy (1.97% vs 3.13%; HR 0.60, 95% CI 0.45-0.79), with no observed increase in MACE (2.73% vs 3.11%; HR 0.88, 0.77-1.02).
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:
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Anticoagulation news items. Week commencing 8th June 2020
JAMA Internal Medicine
Study (n=24,943) found concurrent use of clarithromycin compared with azithromycin was associated with a small, significantly greater 30-day risk of hospital admission with major haemorrhage (adjusted hazard ratio, 1.71 [95% CI, 1.20-2.45]; absolute risk difference, 0.34%).
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:
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Anticoagulation news items. Week commencing 1st June 2020
Circulation
Ticagrelor reduced CV and all-cause mortality (HR 0.82 and 0.83, respectively) whereas there was no significant mortality reduction with prasugrel vs clopidogrel (0.90 and 0.92, respectively). Both prasugrel and ticagrelor increased major bleeding vs clopidogrel (1.26 and 1.27).
British Journal of Clinical Pharmacology
Prospective study (n=1717) found clopidogrel-treated patients had a higher annual rate of cardiovascular mortality, major adverse cardiovascular event and all‐cause mortality (all P< 0.001) without differences in major bleeding (P = 0.587) vs novel oral P2Y12 inhibitors.
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:
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Anticoagulation news items. Week commencing 2nd March to 25th May 2020
British Journal of Clinical Pharmacology
This analysis of 75 observational studies (mainly retrospective) found 25-50% received off-label DOAC doses. Only three directly correlated DOAC dose adjustment with clinical outcome; both under-dosing and over-dosing were associated with an increased risk for adverse events.
American Journal of Cardiology
Review of 4 RCTs (n=42,850) reports no statistically significant increase in the risk of intraocular bleeding with dual antiplatelet therapy using potent P2Y12 inhibitors compared with clopidogrel (40 events v 45 events respectively, risk ratio 0.89, 95% CI 0.58 to 1.36).
NHS England
NHS England will commission human coagulation factor X in hereditary factor X deficiency (all ages) in accordance with the criteria outlined within the commissioning document.
Annals of Internal Medicine
Retrospective analysis of data from 39,351 patients on apixaban, and 39,351 matched patients on rivaroxaban concludes those prescribed apixaban had a lower rate of both ischaemic stroke or systemic embolism and bleeding compared with those prescribed rivaroxaban.
Apixaban versus Warfarin in Patients with Atrial Fibrillation and Advanced Chronic Kidney Disease
Circulation
Study of 269 patients enrolled in ARISTOTLE found that among patients with AF and CrCl 25-30 mL/min, apixaban caused less major bleeding than warfarin (HR 0.34, 95% CI, 0.14-0.80) and major or clinically relevant non-major bleeding (HR 0.35, 95% CI 0.17-0.72).
Venous thromboembolic diseases: diagnosis, management and thrombophilia testing – guidance (NG158)
National Institute for Health and Care Excellence
This guideline covers diagnosing and managing venous thromboembolic diseases in adults. It aims to support rapid diagnosis and effective treatment for people who develop DVT or PE, and covers testing for conditions that can make a DVT or PE more likely.
Rivaroxaban in Peripheral Artery Disease after Revascularization
New England Journal of Medicine
RCT (n=6,564) found that rivaroxaban plus aspirin was superior to aspirin plus placebo for a composite cardiovascular efficacy outcome (multiple cardiovascular outcomes including cardiovascular death) – 17.3% vs 19.9%, HR 0.85, 95% CI 0.76-0.96).
Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation
New England Journal of Medicine
RCT (n=313) found that in patients undergoing TAVI, composite of death from cardiovascular causes, non–procedure-related bleeding, stroke, or myocardial infarction was lower for anticoagulation (AC) alone vs AC plus clopidogrel (31.2% vs 45.5%, -14.3%, 95% CI -25.0 to -3.6).
Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer
New England Journal of Medicine
RCT (n=1,155) found that apixaban was non-inferior to subcutaneous dalteparin for recurrent VTE (5.6% vs 7.9%, p<0.001 for non-inferiority). Major bleeding rates were similar (3.8% vs 4.0%, HR 0.82, p=0.60 for difference).
Rivaroxaban or Enoxaparin in Nonmajor Orthopedic Surgery
New England Journal of Medicine
RCT (n=3,604) found that rivaroxaban was more effective than enoxaparin in the prevention of venous thromboembolic events during a period of immobilisation after nonmajor orthopaedic surgery of the lower limbs (0.2% vs 1.1%, RR 0.25, 95%CI 0.09-0.75).
Circulation
Analysis of the COMPASS trial found that aspirin & rivaroxaban 2.5 mg twice daily provided similar relative benefits on coronary, cerebrovascular, & peripheral endpoints in those with & without diabetes. Absolute benefits in diabetes were higher due to higher baseline risk.
Circulation
Pre-specified analysis of the ODYSSEY OUTCOMES RCT (n=18,924) found that the risk of peripheral artery disease (PAD) events is related to lipoprotein(a) level, but not baseline LDL level. Alirocumab reduced PAD events (HR 0.69, 95% CI 0.54-0.89) in this study vs placebo.
The Effect of PCSK9 Inhibition on the Risk of Venous Thromboembolism
Circulation
Post-hoc analysis of FOURIER and ODYSSEY OUTCOMES trials found evolocumab provided a 31% reduction in VTE vs placebo (p=0.007). The efficacy of evolocumab was higher in patients with a higher baseline Lp(a) level, with authors suggesting Lp(a) modification may attenuate VTE risk.
Circulation
Post-hoc analysis of AUGUSTUS RCT (P2Y12 + aspirin/placebo, and apixaban/vitamin K antagonist, VKA) found that apixaban had a lower or similar risk of bleeding & ischemic outcomes vs VKA and that there was a trade off for aspirin vs placebo for bleeding and ischaemic events.
Biospace Inc.
This medicine has been approved for the treatment and control of bleeding episodes occurring in people aged >/=12 years with haemophilia A or B with inhibitors (neutralising antibodies). The active ingredient is expressed in genetically engineered rabbits.
Annals of Internal Medicine
A haematologist and a hospital doctor reflect on care of a woman hospitalised for a rheumatologic disorder. They consider risks/benefits of chemoprophylaxis, discuss VTE risk stratification (based on US guidance), and recommend which patients should receive chemoprophylaxis.
Circulation
This retrospective, observational study found administration of prothrombin complex concentrates after apixaban or rivaroxaban-related intracranial haemorrhage was associated with excellent or good haemostasis in 81.8% (95% CI 77.9-85.2%), with a 3.8% thrombosis rate.
Attention should be paid to venous thromboembolism prophylaxis in the management of COVID-19
The Lancet
Analysis of a nationwide dataset from China (n=1099) found that among the patients with COVID-19 at high risk of VTE in this cohort, 44 (11%) of 407 also had a high risk of bleeding, highlighting need to adjust dose and duration of anticoagulants and use of mechanical compression.
Rivaroxaban Plasma Levels and Levetiracetam: A Case Report
Annals of Internal Medicine
Animal studies suggest levetiracetam acts as a P-glycoprotein inducer to reduce rivaroxaban plasma levels. This paper presents first reported case of levetiracetam affecting rivaroxaban plasma levels in a human, leading to clinically important reduction in anticoagulation effect.
Off-label Use of Direct Oral Anticoagulants Compared With Warfarin for Left Ventricular Thrombi
JAMA Cardiology
Study (n=514) found DOAC linked to higher risk of stroke/systemic embolism vs. warfarin (HR 2.71; 95% CI, 1.31-5.57; p= 0.01), challenging assumption of DOAC equivalence with warfarin for LV thrombi and highlights need for RCTs to determine most effective treatment strategies.
Pulmonary Embolism in COVID-19 Patients: Awareness of an Increased Prevalence
Circulation
In this letter, authors describe a case-series of COVID-19 patients with pulmonary embolism (PE) admitted into ICU over a period of 1 month, at a single institution in France compared to the same period a year ago, noting a doubling in incidence of PE.
Lupus Anticoagulant and Abnormal Coagulation Tests in Patients with Covid-19
New England Journal of Medicine
In this study of 216 patients with Covid-19 and a prolonged aPTT, 91% were positive for lupus anticoagulant. In the authors opinion however, a prolonged aPTT alone should not be a barrier to the use of anticoagulation in the prevention and treatment of VTE in Covid-19.
Circulation
This policy statement provides a focused review of VTE, risk scoring systems, prophylaxis, and tracking methods. From this summary, 5 major areas of policy guidance are presented that it is hoped will lead to better implementation, tracking, and prevention of VTE events.
British Medical Journal
RCT (n=1905 in UK) found pharmaco-thromboprophylaxis alone is non-inferior to its use in combination with graduated compression stockings (imaging confirmed lower limb DVT or PE with symptoms within 90 days of surgery occurred in 1.7% on LMWH vs. 1.4% on LMWH and GCS).
Covid-19 and thrombosis: what do we know about the risks and treatment?
British Medical Journal
This BMJ news report discusses the observed increased risk of thrombosis in patients with Covid-19. One expert notes that there are still high rates of DVT, PE and immunothrombosis in Covid-19 patients despite prophylaxis, with some arguing that bigger doses should be given.
Annals of Internal Medicine
Study (n=23,515) suggests DOAC use may result in lower risk for osteoporotic fracture vs. warfarin (propensity score–weighted cumulative incidence differences: apixaban, −0.88%, dabigatran, 0.81%, rivaroxaban, −1.13%). Fracture risk does not seem to be altered by choice of DOAC.
Circulation
Study found prevalence of DVT is high and linked to adverse outcomes in hospitalised patients with COVID-19; of 143 patients, 66 (46.1%) developed lower extremity DVT. It suggests VTE prophylaxis may be protective in patients with Padua protection score ≥ 4 after admission.
Coagulation abnormalities and thrombosis in patients with COVID-19
The Lancet Haematology
In this Comment, the authors summarise the characteristics of COVID-19 coagulopathy, coagulation laboratory findings in affected patients, the prohaemostatic state and incidence of thromboembolic events, and potential therapeutic interventions.
BMJ Open
Study (n=361 635 with diabetes; 36 570 prescribed oral anticoagulant [OAC]) reported 50% increase in prevalence of OAC prescribing from 2001- 2015. Warfarin prescribing decreased by 14.0% and prescribing of DOACs increased (0.1 to 17.6 per 100 persons on OACs) during this period.
COVID-19-associated hyperviscosity
The Lancet
Letter describes COVID-19-associated hyperviscosity, a potentially severe consequence of infection with severe acute respiratory syndrome coronavirus 2, in 15 patients tested to date. Authors are exploring any beneficial role of therapeutic plasma exchange.
COVID-19 coagulopathy: an evolving story
The Lancet Haematology
Commentary details the increased incidence of thrombotic complications with COVID-19, and how it can resemble other systemic coagulopathies. It concludes that there is still much to be learned, but the fast and ongoing collaboration worldwide makes for a hopeful outcome.
Revised SPC: Clexane (enoxaparin) preparations
electronic Medicines compendium
SPC now states that for IV (bolus) injection (for acute STEMI indication only), in order to assure the accuracy of the small volume to be injected, it is recommended to dilute the drug to 300 IU/ml (3 mg/ml). Instructions for subsequent administration are also given.
Low molecular weight heparins – should treatment doses be used in patients with renal impairment?
Specialist Pharmacy Service
This updated Medicines Q & A reviews and summarise the evidence available for low molecular weight heparin (LMWH) treatment doses in renal impairment. It summarises ESC advice but states that more comparative data (between LMWHs and unfractionated heparin) are required.
British Journal of Clinical Pharmacology
This study (393 cases, 1494 controls) found among new DOAC users, concurrent use of antiplatelets (adjusted odds ratio 2.01; 95% CI 1.29–3.11) and SSRIs (1.68; 1.10–2.59) was associated with increased risk of major bleeding. Pharmacokinetic interacting drugs did not increase 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
Anticoagulation news items. Week commencing 3rd, 10th, 17th and 24th February 2020
Thrombosis Research
Database review (1.5 million hospitalisations, and 3731 major haemorrhages) found, after accounting for differences in patient characteristics, location of bleed, and traumatic injury, inpatient survival was no different in patients with major haemorrhage on DOAC or warfarin.
Management of acute ischemic stroke
British Medical Journal
This expert review discusses recent updates in secondary prevention recommendations including short term use of dual antiplatelet therapy to prevent recurrent stroke in the high risk period immediately after stroke; as well as emerging therapies and future research.
Oral Anticoagulation for Patients With Atrial Fibrillation on Long-Term Hemodialysis
Journal of the American College of Cardiology
Review of 16studies (n=71,877) concludes oral anticoagulants (OAC) are not associated with reduced risk of thromboembolism in patients with AF on long-term dialysis; warfarin, dabigatran, and rivaroxaban were associated with significantly higher bleeding risk v apixaban or no OAC.
Heart
Review of 7 studies (n=22,014) concludes when compared with clopidogrel, use of ticagrelor (RR 1.36; 95% CI 1.18 to 1.57) and prasugrel (RR 2.11; 95% CI 1.34 to 3.30) were associated with increased rates of bleeding in patients with AF on oral anticoagulants undergoing PCI.
European Heart Journal
Retrospective study suggests lower GI-bleeding during oral anticoagulant therapy should not be dismissed as benign consequence of treatment but always examined for potential underlying malignant cause (absolute 1yr risk:3.7 to 8.1% in age groups ≤65 and 76–80 yrs, respectively).
Atrial fibrillation patients’ experiences and perspectives of anticoagulation therapy changes
Research in Social and Administrative Pharmacy
A thematic analysis on qualitative data from 56 AF patients who experienced a therapy change identified clear opportunities to improve patients' experiences with oral anticoagulant therapy changes through improved shared decision-making and patient education/counselling.
JAMA Internal Medicine
Review of 13 RCTs (n=6060) concludes risk of VTE and adverse effects (risk of major bleeding, wound haematoma or infection) after total hip and knee replacement was not statistically significantly different when using aspirin vs other anticoagulants.
European Heart Journal
Taiwanese study (n=19,414) concludes that compared with warfarin, non-vitamin K antagonist oral anticoagulants were associated with a reduced fracture risk (Hazard Ratio = 0.84, 95% CI 0.77–0.93; P<0.001).
Thrombosis and Haemostasis
Review of 74 RCTs (n=11,322) found that compared with standard INR target (2-3), lower INR ranges (1.5-2) were associated with higher rates of thromboembolism (7.1% vs 4.4%), lower rates of major bleeding (2.2.vs. 4.4%), and similar mortality rates (4.8 v 5.2%).
JAMA Cardiology
Analysis of 5 RCTs (n = 11 542) suggests vitamin K antagonist plus dual antiplatelet therapy should generally be avoided in this population as regimens in which aspirin is discontinued may lead to lower bleeding risk and no difference in antithrombotic effectiveness.
The Lancet Haematology
Study(n=87) confirms this population have high risk of 1st/recurrent VTE during pregnancy,with highest risk in women with +ve family history(FH), but still relevant in those with–ve FH suggesting low-molecular-weight heparin prophylaxis should also be considered in these patients.
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:
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Anticoagulation news items. Week commencing 13th, 20th and 27th January 2020
Revised SPC: Pradaxa (dabigatran) capsules
electronic Medicines compendium
SPC now advises that concomitant administration with glecaprevir/pibrentasvir is contraindicated owing to increased risk of bleeding due to increased dabigatran levels. Also, alopecia has been added as a potential adverse effect of treatment (frequency unknown).
American Journal of Cardiology
Review of 9 studies (n=13,437) found no statistically significant difference in mortality, nonfatal myocardial infarction, stent thrombosis, and stroke between double and triple antithrombotic therapy (DATT and TATT). DATT had a lower rate of bleeding (RR 0.64, 95% CI 0.54-0.75).
JAMA Internal Medicine
Cohort study (n=11,185) concludes ticagrelor was not associated with lower risk of major adverse coronary events (HR 0.97; 95% CI, 0.85-1.10); however, it was associated with an increased risk of major bleeding (1.51; 1.29-1.78) and dyspnoea vs clopidogrel (1.98; 1.47-2.65).
Journal of the American Medical Association
RCT (n=813) reports postoperative osocimab 0.6mg/kg, 1.2mg/kg, and 1.8mg/kg met criteria for noninferiority vs enoxaparin, and the preoperative 1.8mg/kg dose of osocimab met criteria for superiority vs enoxaparin in incidence of VTE (primary outcome) at 10-13 days postoperatively.
Low molecular weight heparins – should prophylactic doses be used in patients with renal impairment?
Specialist Pharmacy Service
In contrast to unfractionated heparin, low molecular weight heparins are primarily cleared via kidney thus care needed in renal impairment (RI) because they can accumulate and increase bleeding Risk. Q&A reviews current literature on use of prophylactic doses in patients with RI.
Direct acting oral anticoagulants and alopecia: the valuable support of post marketing data
British Journal of Clinical Pharmacology
Analysis identified 1316 reports on VigiBase, most concerning rivaroxaban (58.8%). Overall, 80% of reports were related to females, in particular to those ≥65 years old (23.1%).Median time‐to‐onset was 28 days (IQR 63 days). In 54.3% of reports, causality was assessed as possible.
Thrombosis and Haemostasis
In analysis of 3 RCTs (n=2661), use of NOACs was linked to similar incidence of stroke/systemic embolism, ischaemic stroke, venous thromboembolism, all-cause death and major bleeding vs. vitamin K antagonists. Results were confirmed in secondary analysis (3 observational studies).
Ticagrelor hits primary endpoint in the THALES Phase III trial for use in stroke
PharmaTimes
In this study, the manufacturers report that ticagrelor 90 mg twice daily plus aspirin for 30 days showed a statistically significant and clinically meaningful reduction in the risk of stroke and death vs aspirin alone.
European Medicines Agency
Treprostinil sodium is a prostacyclin analogue which has a direct vasodilatory effect on pulmonary and systemic arterial circulation, and inhibits platelet aggregation.
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:
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Anticoagulation news items. Week commencing 6th January 2020
Circulation
Review of patients with incident NSAID use in the ARISTOTLE trial (n=2185) found that incident NSAID use was associated with an increased risk of major bleeding (HR 1.61, 95% CI 1.11-2.33) and relevant non-major bleeding (1.70, 1.16-2.48).
Heart
US-Registry shows among 4120 patients on DOACs, 154 (3.7%) patients had a CrCl decline sufficient to warrant FDA-recommended dose reductions and only 31 patients underwent dose reduction. Those without dose reduction experienced major bleeding 1.7% vs 0% at 1 year.
Apixaban and dalteparin in active malignancy‐associated venous thromboembolism: The ADAM VTE trial
Journal of Thrombosis and Haemastasis
RCT (n=300) found a lower rate of major bleeding and recurrent VTE with apixaban vs dalteparin (0% vs 1.4% and 0.7% vs 6.3%, p<0.05 for both). Rates of major bleeding or clinically relevant non-major bleeding were similar in the two groups (6%).
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:
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Anticoagulation news items. Week commencing 16th December 2019
Antidepressant drug use and subdural hematoma risk
Journal of Thrombosis and Haemastasis
Study (10,885 subdural hematoma (SDH) cases & 435,379 matched controls) found SSRIs (adjusted OR 1.32 [1.25‐1.38]) and non‐SSRIs (aOR 1.19 [1.13‐1.26]) were associated with higher SDH risk vs. non‐use of antidepressants; but absolute risk is judged to be small.
National Institute for Health Research
Meta-analysis (n=6857; 13 trials) found thromboprophylaxis (TP) in this setting is clinically (low-molecular-weight heparin reduced risk any VTE: OR 0.52, 95% CI, 0.37-0.71) and cost (£13,524 per QALY) effective vs. no TP. Estimates of risk of major bleeding were inconclusive.
British Journal of Clinical Pharmacology
Study (n=4427) found patients with treatment errors (ERs) hospitalised for AF/with stroke history more likely to have such ERs corrected but many ERs are still overlooked. After nontreatment, DOAC underdosing and vitamin K antagonists use instead of DOAC are most common ER types.
PharmaTimes
In trials, Hemlibra dosed once-weekly or every two weeks led to statistically significant reduction in treated bleeds compared to on-demand treatment. In pooled data a high proportion of patients, both with and without inhibitors, achieved zero treated bleeds.
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
