Friday, 13 January 2017 20:12

Anticoagulation news items. Weeks commencing 9th January 2017

Discontinuation of Warfarin Therapy for Patients With Atrial Fibrillation: The Michigan Anticoagulation Quality Improvement Initiative Experience

JAMA Cardiology

Research letter-reports on study (n=734) which showed high rate of discontinuation of warfarin within first year (36.8%), especially among patients undergoing electrical cardioversion or radiofrequency ablation (54.1% vs.29.5% not undergoing these procedures; p<0.001).

 

Antifibrinolytic therapy to reduce haemoptysis from any cause

Cochrane Database of Systematic Reviews

There is insufficient evidence to judge whether antifibrinolytics should be used to treat haemoptysis from any cause, though limited evidence suggests they may reduce the duration of bleeding.

 

Safety profile of the direct oral anticoagulants: an analysis of the WHO database of adverse drug reactions

British Journal of Clinical Pharmacology

This analysis of 32,972 reports of adverse events (from WHO VigiBase database) shows increased risk of gastrointestinal haemorrhage in patients treated with
direct oral anticoagulants vs warfarin (OR 1.6, p≤0.05), and a reduced risk of intracranial haemorrhage (OR 0.31, p≤0.05).

 

Heparin for the treatment of thrombosis in neonates

Cochrane Database of Systematic Reviews

No studies were identified that met the inclusion criteria for this evaluation, and therefore no recommendations can be made for the use of heparin for the
treatment of neonates with thrombosis.

 

A novel risk prediction score in atrial fibrillation for a net clinical outcome from the ENGAGE AF-TIMI 48 randomized clinical trial

European Heart Journal

This paper describes development of a risk score (TIMI-AF) using data from ENGAGE AF-TIMI 48 trial (edoxaban vs. warfarin) to identify vitamin K antagonist
(VKA) naive patients for whom a therapeutic benefit of non-vitamin K antagonist oral anticoagulants over a VKA is predicted.

 

Prospective study of oral anticoagulants and risk of liver injury in patients with atrial fibrillation

Heart

Analysis (n=113,717 with AF, mean age 70, 39% women) found that over median 12 months follow-up, there were 960 hospitalisations with liver injury with rates for following anticoagulants: 9 (warfarin), 4.0 (dabigatran), 6.6 (rivaroxaban) and 5.6 (apixaban), per 1000 person-years.

 

Combined Intravenous Thrombolysis and Thrombectomy vs Thrombectomy Alone for Acute Ischemic Stroke: A Pooled Analysis of the SWIFT and STAR Studies

JAMA Neurology

Analysis (n=291) found that treatment of patients experiencing acute ischaemic stroke due to a large vessel occlusion with intravenous thrombolysis before
mechanical thrombectomy (MT) did not appear to provide a clinical benefit over MT alone.

 

Thrombolytic removal of intraventricular haemorrhage in treatment of severe stroke: results of the randomised, multicentre, multiregion, placebo-controlled CLEAR III trial

The Lancet

RCT (n=500) found in patients with intraventricular haemorrhage and routine extraventricular drain, irrigation with alteplase did not substantially improve functional outcomes (modified Rankin Scale score ≤3 at 180 days) compared with irrigation with saline, but seems safe.

 

Afstyla (recombinant human coagulation factor VIII, single chain) approved in EU for treatment of haemophilia A

Biospace Inc.

Afstyla, the first and only single-chain product, is approved for treatment and prophylaxis of bleeding in patients with haemophilia A (congenital factor
VIII deficiency) in all age groups. It is specifically designed for protection from bleeds with 2 or 3 times weekly dosing.

 

Biologic Licence Application for coagulation factor VIIA recombinant, (Eptacog beta activated) accepted for review by FDA

Biospace Inc.

The pivotal phase 3 trial supporting licence application for this new treatment for patients with haemophilia A and B tested two initial dose regimens in 468
bleeding events occurring in 27 inhibitor patients. Both study arms met the primary end point of haemostatic success.

 

Oral anticoagulation in end-stage renal disease and atrial fibrillation: is it time to just say no to drugs?

Heart

Review notes clinicians who initiate vitamin K antagonists in this group should expect substantial lability in anticoagulant activity and pursue an aggressive monitoring strategy; use of DOACs in moderate renal impairment pose theoretical risks and lack safety data in dialysis.

 

Statins and primary prevention of venous thromboembolism: a systematic review and meta-analysis

The Lancet Haematology

Review of 13 cohort studies and 23 RCTs (total n=3,266,723) found a pooled RR for VTE of 0.75 (95% CI 0.65-0.87) for cohort studies and 0.85 (0.73-0.99) for RCTs for statin vs placebo or no treatment. Rosuvastatin had the lowest risk vs other statins (RR 0.57, 0.42-0.75).

 

 

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