Friday, 09 February 2018 19:11

Anticoagulation news items. Week commencing 5th and 12th February 2018

Parenteral anticoagulation in ambulatory patients with cancer

Cochrane Database of Systematic Reviews

Review of 19 RCTs (n=9650) suggests heparin appears to have no effect on mortality at 12 and 24 months. Whilst it reduces symptomatic VTE, it likely increases major and minor bleeding. The decision for a patient with cancer to start heparin therapy should balance risks/benefits.


NIHR Signal: Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrial fibrillation

National Institute for Health Research Signal

An expert comment is provided of a network meta-analysis which compared 4 DOACs at various doses, warfarin and an antiplatelet agent for prevention of strokes in people with AF concluding apixaban 5mg bd was the most effective and safest intervention for several outcomes.


Less dementia with oral anticoagulation in atrial fibrillation

European Heart Journal

Analysis of data from Swedish Registry (n=444,106) reports anticoagulant treatment at baseline was associated with 29% lower risk of dementia than patients without anticoagulant treatment (incidence rate of dementia 1.14 vs. 1.78 per 100 patient years at risk, P < 0.001).


Atrial fibrillation – Updated Quality Standard [QS93]

National Institute for Health and Care Excellence

This updated quality standard has been changed to include edoxaban as an option for anticoagulation in the "rationale and definition" section; this reflects the NICE technology appraisal on edoxaban for preventing stroke and systemic embolism in people with non-valvular AF.


Current evidence of oral anticoagulant reversal: A systematic review

Thrombosis Reasearch

Review of 33 studies (4783 on vitamin K antagonist [VKA] and 529 on DOACs) supports use of prothrombin complex for VKA reversal. There are no studies on clinical efficacy of non-specific agents for DOAC reversal and inconsistent evidence for laboratory reversal.


Association of different antiplatelet therapies with mortality after primary percutaneous coronary intervention

European Journal of Heart Failure

Compared to clopidogrel (n>89,000), prasugrel was associated with lower mortality at 30 days (OR 0.87, 95% CI 0.78 to 0.97, P=0.014) and 1 year (0.89; 0.82 to 0.97, P=0.011) post PCI but ticagrelor was not.


NIHR Signal: Rivaroxaban plus aspirin may reduce heart attack and strokes in people with peripheral arterial disease (PAD), but with an added risk of bleeding

National Institute for Health Research Signal

Commentary notes the combination of low dose rivaroxaban plus aspirin could reduce risk of CV death, heart attack and stroke at the expense of a small increase in major bleeding in patients with stable PAD; a cost-effectiveness analysis would be helpful to determine net benefit.


Moving anticoagulation initiation and monitoring services into the community: evaluation of the Brighton and Hove community pharmacy service

BMC Health Services Research

The majority (98.6%) of patients attending a Community Pharmacy Anticoagulation Management Service rated it as good, very good or excellent, with 65.4% of INR readings within the target range (national target 60%) and 72.5% of time spent in therapeutic range (national target 70%).


Ischaemic stroke, haemorrhage, and mortality in older patients with chronic kidney disease newly started on anticoagulation for atrial fibrillation: a population based study from UK primary care

British Medical Journal

In patients aged ≥65 with chronic kidney disease, receipt of an anticoagulant within 60 days of AF diagnosis was associated with an increased risk of ischaemic stroke (HR 2.60; 95% CI 2.00 to 3.38) and haemorrhage (2.42; 1.44 to 4.05) but a lower risk of all-cause mortality.


Impact of anticoagulation therapy on valve haemodynamic deterioration following transcatheter aortic valve replacement


Study (n=2466) found lack of anticoagulation post-transcatheter aortic valve replacement was linked to significant increments in transvalvular gradients and greater risk of valve haemodynamic deterioration, which was not linked to major adverse clinical events in most cases.


 New Product: Enoxaparin BECAT pre-filled syringes with safety device

electronic Medicines compendium

This biosimilar enoxaparin is licensed for the treatment and prophylaxis of thromboembolism, for prevention of thrombus formation in extracorporeal circulation during haemodialysis, and treatment of acute coronary syndromes.


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: