Management of antithrombotic therapy after bleeding in patients with coronary artery disease and/or atrial fibrillation: expert consensus paper of the European Society of Cardiology Working Group on Thrombosis

European Heart Journal

While waiting for observational and randomised data to accrue, this consensus paper offers a European perspective on managing antithrombotic therapy after
bleeding in patients with coronary artery disease and/or AF, including which drugs to stop, which to restart, and when.

Patterns of antiplatelet drug use after a first myocardial infarction during a 10-year period

British Journal of Clinical Pharmacology

Trial (n=4690) found persistent users decreased from 84.0% at 1-year to 32.8% at 10 years for any antiplatelet [AP: 77.3% to 27.5% for aspirin; 39.0% to 6.4% for clopidogrel at 6 years]. Most nonpersistent users restarted, leading to 89.3% overall AP users at 10 years post MI.

Medicines Optimisation in Atrial Fibrillation

Specialist Pharmacy Service

First section of this document shows how to use nationally available data to build picture of care and assess quality of AF management for any locality. Second
section provides short review protocol for patients on AF register which can be used to optimise their anticoagulation.

Non-major bleeding with apixaban versus warfarin in patients with atrial fibrillation

Heart

In this RCT (n=18,140) non-major bleeding was reported less frequently with apixaban (6.4/100 patient-years) than warfarin (9.4/100 patient-years) (adjusted HR 0.69, 95% CI 0.63 to 0.75) and was associated with fewer adverse outcomes including mortality and subsequent major bleed.

Conference report: Two real-world studies confirm positive efficacy and safety profile of rivaroxaban taken for longer than 3 months for venous thromboembolism (VTE)

Biospace Inc.

At 6 months, recurrent VTE occurred in 1.07% of people in the continued cohort and 2.10% in the discontinued cohort (p<0.05) whilst major bleeding occurred in 0.79% and 0.72% respectively (p>0.05). Similar findings were reported at 12 months.

Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery

New England Journal of Medicine

Study (n=4631) found no significant difference in death/thrombotic complications within 30 days of surgery between tranexamic acid and placebo (16.7% vs.
18.1%, respectively). Tranexamic acid was associated with a lower risk of bleeding vs placebo.

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