Saturday, 30 September 2017 10:38

Anticoagulation news items. Week commencing 25th September 2017

Miconazole (Daktarin): over-the-counter oral gel contraindicated in patients taking warfarin

Medicines and Healthcare products Regulatory Agency

Patients taking warfarin should not use over-the-counter miconazole oral gel. If concomitant use is planned via prescription, the anticoagulant effect of warfarin should be monitored carefully. Patients who experience signs of bleeding should seek immediate medical attention.

 

Meta-Analysis of Safety and Efficacy of Uninterrupted Non–Vitamin K Antagonist Oral Anticoagulants Versus Vitamin K Antagonists for Catheter Ablation of Atrial Fibrillation

American Journal of Cardiology

Review of 13 studies (3 RCTs and 10 observational studies, total n=4,878) found no significant difference in the risk of major bleeding, systemic thromboembolism and symptomatic stroke/TIA, though the evidence was not of high quality.

 

Evolving landscape of stroke prevention in atrial fibrillation within the UK between 2012 and 2016: a cross-sectional analysis study using CPRD

BMJ Open

Cohort study showed an increasing proportions of patients with non-valvular AF receiving anticoagulant therapy (16.7% rise), together with similar reductions in antiplatelet (16.8% decrease). The proportion of patients not receiving antithrombotics remained the same (15%).

 

Effect of Genotype-Guided Warfarin Dosing on Clinical Events and Anticoagulation Control Among Patients Undergoing Hip or Knee Arthroplasty: The GIFT Randomized Clinical Trial

Journal of the American Medical Association

RCT (n=1,650) found that fewer patients in the geno-type guided group had a composite outcome event (major bleeding, INR>4, VTE or death) vs clinically guided warfarin (10.8% vs 14.7%, RR 0.73, 95% 0.56 to 0.95).

 

Phase III L-PLUS2 study investigating lusutrombopag for the treatment of thrombocytopenia in patient with chronic liver disease undergoing elective invasive procedures meets primary endpoint

Biospace Inc.

This study (n=215) reports that more patients on lusutrombopag vs placebo (64.8% vs 29.0%) met the primary efficacy endpoint (defined as proportion of patients who required no platelet transfusion prior to the invasive procedure) and no rescue therapy for bleeding post procedure.

 

Interhospital Transfer Prior to Thrombectomy is Associated with Delayed Treatment and Worse Outcome in the STRATIS Registry

Circulation

Median onset-to-revascularisation time was 202 minutes for direct presentation vs 311 minutes for interhospital transfer in 984 patients undergoing mechanical thrombectomy for severe stroke (p<0.001). Mortality did not differ and IV alteplase did not impact outcomes.

 

New Drug Application submission to FDA for avatrombopag, an oral second generation thrombopoietin receptor agonist

Biospace Inc.

The NDA was based on data from two Phase III trials, ADAPT-1 and ADAPT-2, that evaluated the efficacy and safety of avatrombopag for the treatment of severe thrombocytopenia (<50,000/μL) in patients with chronic liver disease who are scheduled to undergo a procedure.

 

Diagnosis and management of postpartum haemorrhage

British Medical Journal

Review notes this is second leading direct cause of maternal deaths in UK. It recommends tranexamic acid for all women with atonic and traumatic postpartum haemorrhage as well as for ongoing haemorrhage during a caesarean section.

 

National community pharmacy oral anticoagulant safety audit

Specialist Pharmacy Service

This audit will provide insight on patient awareness of key information about their anticoagulant, use of alert cards and compliance with monitoring requirements. Results will be used to inform a national update of patient held oral anticoagulant information and alert cards.

 

 

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