Friday, 24 February 2017 19:56

Anticoagulation news items. Weeks commencing 20th February 2017

Myocardial Infarction Risk after Discontinuation of Thienopyridine Therapy in the Randomized DAPT Study

Circulation

Among 11,648 randomised patients, monthly cumulative incidence of MI was lower with continued thienopyridine vs. placebo at 12-15 months (0.12% vs. 0.37%, p<0.001) and higher at 30-33 months (0.30% vs. 0.15%, p=0.013). Majority of MIs were not related to stent thrombosis.

 

Real-life treatment of venous thromboembolism with direct oral anticoagulants: The influence of recommended dosing and regimens

Thrombosis and Haemostasis

Spanish registry study (n=1725) noted patients on DOACs at non-recommended doses and/or regimens experienced higher rate of venous thromboembolism recurrences (HR:10.5;95 %CI:1.28–85.9) and similar rate of major bleeding/death vs. those on recommended doses and regimens.

 

Effect of Fibrinogen Concentrate on Intraoperative Blood Loss Among Patients With Intraoperative Bleeding During High-Risk Cardiac Surgery: A Randomized Clinical Trial

Journal of the American Medical Association

RCT (n=120) found among patients with intraoperative bleeding during high-risk cardiac surgery, administration of IV single dose fibrinogen concentrate, vs.
placebo, resulted in no significant difference in the amount of intraoperative blood loss (50 vs. 70mL, respectively).

 

New product: FibCLOT 1.5 g. powder and solvent for solution for injection/infusion (human fibrinogen)

electronic Medicines Compendium

FibCLOT is licensed for the treatment and perioperative prophylaxis of bleeding in patients with congenital hypo- or afibrinogenaemia with bleeding tendency.

 

Outcomes Associated With Resuming Warfarin Treatment After Hemorrhagic Stroke or Traumatic Intracranial Hemorrhage in Patients With Atrial Fibrillation

JAMA Internal Medicine

Study of 2415 patients who experienced a traumatic intracranial haemorrhage (ICH) or haemorrhagic stroke (HS) showed resuming warfarin therapy was associated with lower rate of ischaemic stroke or systemic embolism. However, in those with HS, a high rate of ICH was observed.

 

Effects of dabigatran according to age in atrial fibrillation

Heart

Analysis (n=10855) found effects of dabigatran vs. warfarin on stroke prevention/intracranial bleeding were consistent across all ages. Effects of dabigatran on extracranial major bleeding were age dependent, supporting use of 110 mg BD dose for elderly patients (≥80 years).

 

Drug-induced liver injury (DILI) with oral anticoagulants: a threat or not?

Heart

This editorial discusses the background of DILI, highlighting that it can develop with the use of nearly any drug. It then goes on to discuss the current
evidence base for DILI with oral anticoagulants, reviewing the use of the newer drugs in liver impairment vs. warfarin.