Friday, 13 July 2018 18:58

Anticoagulation news items. Week commencing 9th July 2018

Anticoagulation therapy in patients with stroke and atrial fibrillation: a registry-based study of acute stroke care in Surrey, UK

BMJ Open

Study (n=3309) found that atrial fibrillation (AF) occurred more frequently in patients admitted with recurrent (30.2%) vs first stroke (17.1%). Of 666 (20.1%) patients with history of AF, 45.3% were anticoagulated, 41.9% untreated and 12.8% deemed unsuitable for anticoagulation.

 

Anticoagulation and Antiplatelet Strategies After On-X Mechanical Aortic Valve Replacement

Journal of the American College of Cardiology

RCT (n=576) found, that for low thrombotic risk patients, dual antiplatelet therapy had higher rates of thromboembolism vs warfarin plus aspirin (3.12% vs 0.29% per patient/year, p=0.02).

 

Effect of Alteplase vs Aspirin on Functional Outcome for Patients With Acute Ischemic Stroke and Minor Nondisabling Neurologic Deficits: The PRISMS Randomized Clinical Trial

Journal of the American Medical Association

RCT (n=313) found that in those with non-disabling stroke, treatment with alteplase did not increase the likelihood of favourable functional outcome at 90 days vs aspirin. Symptomatic intracranial haemorrhage was more common with alteplase (3.2% vs 0%, p<0.05).

 

New product: AROVI (enoxaparin biosimilar) pre-filled syringes with safety device

electronic Medicines compendium

This enoxaparin biosimilar comes as 2,000 IU (20mg/0.2ml), 4,000 IU (40mg/0.4ml), 6,000 IU (60mg/0.6ml), 8,000 IU (80mg/0.8ml), 10,000 IU (100mg/1ml), 12,000 IU (120mg/0.8ml) and 15,000 IU (150mg/1ml) pre-filled syringes with safety device.

 

Clinical Commissioning Policy: Emicizumab as prophylaxis in people with congenital haemophilia A with factor VIII inhibitors (all ages)

NHS England

NHS England will routinely commission this specialised treatment. The arrangements and criteria for funding of this treatment for the population in England is outlined in this policy document.

 

Clinical Commissioning Policy: Susoctocog alfa for treating bleeding episodes in people with acquired haemophilia A (all ages)

NHS England

NHS England will routinely commission this specialised treatment. The arrangements and criteria for funding of this treatment for the population in England is outlined in this policy document.

 

Outcomes in anticoagulated patients with atrial fibrillation and with mitral or aortic valve disease

Heart

Analysis (n=14,793) found in anticoagulated AF patients, aortic stenosis (AS) is linked to higher risk of stroke/systemic embolism, bleeding/death. Efficacy and safety benefits of apixaban vs. warfarin were consistent regardless of presence of mitral/aortic regurgitation or AS.

 

Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016

Heart

17 sequential cross-sectional analyses found prevalence of recorded AF has increased from 2000 to 2016 (2.14 to 3.29%); anticoagulation of eligible patients with AF has more than doubled (35.4 to 75.5% in high stroke risk group), alongside decrease in use in ineligible patients.

 

Effects of aspirin on risks of vascular events and cancer according to bodyweight and dose: analysis of individual patient data from randomised trials

The Lancet

Analysis of 10 trials of aspirin in primary prevention (n=117,279) found low doses (75–100mg) were only effective in preventing vascular events in patients weighing <70kg, and had no benefit in 80% men and~ 50% women ≥70kg. Higher doses were only effective in patients ≥70kg.

 

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