Friday, 02 September 2016 21:14

Anticoagulation news items. Weeks commencing 29th August 2016

Efficacy and safety of left atrial appendage closure versus medical treatment in atrial fibrillation: a network meta-analysis from randomised trials

Heart

Analysis of 19 RCTs (n=87,831) suggests procedure is superior to placebo and antiplatelets, and comparable to NOACs for preventing mortality and stroke/systemic embolism, with similar bleeding risk. However, wide confidence intervals for variables warrants cautious interpretation.

 

Peri-operative management of anticoagulation and antiplatelet therapy

British Committee for Standards in Haematology

Previous guideline on warfarin (2011) has been updated to include management of patients on direct oral anticoagulants and antiplatelet agents which are
becoming frequent clinical queries. This guideline considers whether and when such agents should be stopped and restarted.

 

Impact of Optimal Medical Therapy in the Dual Antiplatelet Therapy Study

Circulation

Analysisof 11,643 patients noted that continued thienopyridine therapy reduced the rate of MI regardless of optimal medical therapy status and had consistent
effects on reduction in major adverse cardiovascular and cerebrovascular events and increased bleeding.

 

Long-term efficacy of catheter ablation as first-line therapy for paroxysmal atrial fibrillation: 5-year outcome in a randomised clinical trial

Heart

Pre-specified 5 year follow-up of 245 of 294 patients (83%) randomised to radiofrequency catheter ablation (RFA) or antiarrhythmic drug therapy (AAD) in MANTRA-PAF trial found that occurrence and burden of any AF and symptomatic AF were significantly lower in RFA group.

 

Net clinical benefit of warfarin in individuals with atrial fibrillation across stroke risk and across primary and secondary care

Heart

Cohort study (n=70,206 with AF in primary/secondary car, England 1998–2010) noted CHA2DS2-VASc accurately stratifies ischaemic stroke risk, but incidence rate at CHA2DS2-VASc=1 was lower than previously reported, which may change decision to start warfarin in this group.

 

Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa Inhibitors

New England Journal of Medicine

Descriptive preliminary analysis of study (n=67 with acute major bleeding within 18 hours after administration of factor Xa inhibitor), an initial bolus and subsequent 2-hour infusion of andexanet reduced anti–factor Xa activity, with effective haemostasis occurring in 79%.

 

Platelet function monitoring to adjust antiplatelet therapy in elderly patients stented for an acute coronary syndrome (ANTARCTIC): an open-label, blinded-endpoint, randomised controlled superiority trial

The Lancet

In this RCT (n=877) assessing effect of platelet function monitoring with treatment adjustment vs no monitoring, the rate of occurrence of primary endpoint
(composite of CV death, MI, stroke, stent thrombosis, urgent revascularisation and bleeding) did not differ between groups.

 

Prevention of Stroke with Ticagrelor in Patients with Prior Myocardial Infarction: Insights from PEGASUS-TIMI 54

Circulation

RCT (n=14,112) showed that addition of ticagrelor 60 mg bd to aspirin in patients with prior myocardial infarction significantly reduced the risk of stroke vs
placebo [HR 0.75 (0.57–0.98) p=0.034] without an excess of hemorrhagic stroke but with more major bleeding.

 

Edoxaban versus enoxaparin–warfarin in patients undergoing cardioversion of atrial fibrillation (ENSURE-AF): a randomised, open-label, phase 3b trial

The Lancet

This RCT (n=2199) showed rates of thromboembolism and major bleeding were low and similar in the 2 treatment groups and across different patient strata,
including those on reduced edoxaban dose due to renal impairment/bodyweight ≤60kg and on concomitant P-glycoprotein inhibitors.

 

Prasugrel versus Ticagrelor in Patients with Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention: Multicenter Randomized PRAGUE-18 Study

Circulation

In this RCT (n=1230) evaluating prasugrel v ticagrelor prior to PCI, no difference in occurrence of primary endpoint at 7 days (death, re-infarction, urgent target vessel revascularization, stroke, serious bleeding requiring transfusion or prolonging hospitalisation) was noted.

 

2016 ESC Guidelines for the management of atrial fibrillation

European Heart Journal

The European Society of Cardiology has issued guidance on the diagnosis and management of patients with atrial fibrillation.

 

 

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