Friday, 21 April 2017 19:34

Anticoagulation news items. Week commencing 10th and 17th April 2017

Risk of venous thromboembolism in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: a general population-based cohort study

European Heart Journal

This analysis of UK data reports that all three diseases were associated with an increased risk of venous thromboembolism, highest for rheumatoid arthritis (HR 1.29; 95% CI 1.18–1.39 for no DMARD and 1.35, 95% CI 1.27–1.44 for DMARD). An interaction with DMARDs was significant.

 

Treatment of Patients With Atrial Fibrillation and Heart Failure With Reduced Ejection Fraction

Circulation

This review discusses the available data for the treatment of AF in patients who have heart failure with reduced ejection fraction, looks at areas where more investigation is necessary, and presents suggestions for individualised treatment strategies for specific patient groups.

 

Late thrombotic events after bioresorbable scaffold implantation: a systematic review and meta-analysis of randomized clinical trials

European Heart Journal

Review of 5 RCTs (n=1,730) found that patients treated with bioresorbable vascular scaffolds had a higher risk of device thrombisis vs those treated with everolimus eluting stents (OR 2.93, 95% CI 1.37-6.26). There was no statistical difference in risk of target lesion failure.

 

NIHR Signal: Thrombolysis may reduce complications of deep vein thrombosis

National Institute for Health Research Signal

Expert commentary is provided for a systematic review which found that thrombolysis reduced the risk of post-thrombotic syndrome. This benefit however would come at the cost of and increased risk of bleeding. The role of thrombolysis in deep vein thrombosis requires clarification.

 

Anticoagulation reversal for supratherapeutic International Normalized Ratio: A teachable moment

JAMA Internal Medicine

This article describes a case report of a woman in her 80s who underwent anticoagulation reversal, and highlights that fresh frozen plasma transfusions in certain patients with non-urgent conditions can lead to transfusion-associated circulatory overload.

 

Potent P2Y12 Inhibitors in Men Versus Women A Collaborative Meta-Analysis of Randomized Trials

Journal of the American College of Cardiology

Meta-analysis of 7 studies (n=87,840) found no significant difference in efficacy (reduction in risk of major cardiovascular adverse events, myocardial infarction, and stent thrombosis) or safety (major bleeding) for the use of P2Y12 inhibitors in men and women.

 

Effectiveness and safety of rivaroxaban and warfarin in patients with unprovoked venous thromboembolism: a propensity-matched nationwide cohort study

The Lancet Haematology

Danish cohort study (n=4,679 propensity matched patients) found lower rates of recurrent VTE at 6 months for rivaroxaban compared to warfarin (9.9 incidents per 100 person-years vs 13.1 HR 0.74, 95%CI 0.56-0.96). Bleeding rates were similar.

 

Perioperative clopidogrel is associated with increased bleeding and blood transfusion at the time of lower extremity bypass

Journal of Vascular Surgery

Study (n=9179) found perioperative clopidogrel (vs. non use) in lower extremity bypass surgery is linked to increased blood loss (21% vs 12%; p<0.001) and blood transfusion (38% vs 24%; p<0.001), with associated clinical sequelae of increased cardiac and pulmonary complications.

 

 

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