Friday, 21 September 2018 18:13

Anticoagulation news items. Week commencing 17th September 2018

Avatrombopag Before Procedures Reduces Need for Platelet Transfusion in Patients With Chronic Liver Disease and Thrombocytopenia

Gastroenterology

The ADAPT-1 and ADAPT-2 RCTs reported superiority of avatrombopag vs placebo in reducing need for platelet transfusions or rescue procedures for bleeding in patients with thrombocytopenia and chronic liver disease undergoing a scheduled procedure.

 

Anticoagulation for the long‐term treatment of venous thromboembolism in people with cancer

Cochrane Database of Systematic Reviews

Review of 16 RCTs (n= 5167) found evidence showing that low molecular weight heparins (LMWHs) vs. vitamin K antagonists probably produces an important reduction in venous thromboembolism (VTE); and DOACs vs. LMWH, may likely reduce VTE but may increase risk of major bleeding.

 

Long-Term Risk of Venous Thromboembolism in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

Journal of Clinical Oncology

Study reports childhood cancer survivors are at increased risk for VTE across their lifespan and a diagnosis of VTE increases mortality risk. Late VTE incidence among survivors and siblings was 1.1 and 0.5 events /1000 person-years, respectively (RR, 2.2; 95% CI, 1.7 to 2.8).

 

Effect of Aspirin on All-Cause Mortality in the Healthy Elderly

New England Journal of Medicine

RCT (n=19,114) found an increased risk of death from any cause for aspirin vs placebo (12.7 vs 11.1 events/1000 person-years, HR 1.14, 95% CI 1.01-1.29). Cancer was the major contributor to higher mortality with aspirin accounting for 1.6 excess deaths/1000 person-years.

 

Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly

New England Journal of Medicine

RCT (n=19,114) found no difference in rate of cardiovascular disease for aspirin vs placebo (10.7 vs 11.3 events/1000 person-years, HR 0.95, 95% CI 0.83-1.08). Major haemorrhage was more common with aspirin (8.6 vs 6.2 events/1000 person years, 1.38, 1.18-1.62).

 

Effect of Aspirin on Disability-free Survival in the Healthy Elderly

New England Journal of Medicine

RCT (n=19,114) found no difference in the composite rate of death, dementia and persistent physical disability for aspirin vs placebo (21.5 vs 21.2 events/1000 person-years, HR 1.01, 95% CI 0.92-1.11). Major haemorrhage was more common with aspirin (3.8% vs 2.8%, 1.38, 1.18-1.62).

 

Coagulation Test Interpretation in a Patient Taking Direct Oral Anticoagulant Therapy

Journal of the American Medical Association

This short review, in the form of a case vignette, highlights that DOAC-specific coagulation tests such as anti-Xa assay and dilute thrombin time may help guide clinical decisions in bleeding patients or in those requiring urgent surgery. Time of last dose needs to be considered.

 

Prothrombin Complex Concentrates for Perioperative Vitamin K Antagonist and Non–vitamin K Anticoagulant Reversal

Anesthesiology

Review found concentrate was consistently shown to reduce INR rapidly and control bleeding effectively. In studies vs. plasma, it was linked to more patients achieving target INRs rapidly, with improved haemostasis, and no differences in thromboembolic event rates were seen.

 

Antithrombotic treatment is associated with intraplaque haemorrhage in the atherosclerotic carotid artery: a cross-sectional analysis of The Rotterdam Study

European Heart Journal

In a large population-based sample of individuals with subclinical carotid atherosclerosis, current and past use of antithrombotics was linked to intraplaque haemorrhage (IPH) in carotid artery plaques. Longer duration of use and higher doses were linked higher frequency of IPH.

 

Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial

The Lancet

RCT (n=12,546; EC aspirin 100mg/d vs. placebo) found event rate was much lower than expected, making study more representative of a low-risk population, and role of aspirin in primary prevention could therefore not be addressed in patients at moderate risk of CVD.

 

European CHMP recommends granting of marketing authorisation for damoctocog alfa pegol (Jivi) for treatment of haemophilia A (congenital factor VIII deficiency)

European Medicines Agency

Damoctocog is a recombinant human factor VIII which replaces the missing coagulation factor VIII needed for effective haemostasis. It will be available as powder and solvent for solution for injection (250 IU, 500 IU, 1000 IU, 2000 IU and 3000 IU).

 

 

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