Friday, 26 October 2018 19:09

Anticoagulation news items. Week commencing 15th and 22nd October 2018

Extended treatment of venous thromboembolism: a systematic review and network meta-analysis

Heart

Review of 16 studies (n=22,000) found that, for extended treatment, vitamin K antagonists (VKAs) and direct oral anticoagulants reduced the risk of recurrent venous thromboembolisms vs aspirin. The risk of bleeding was higher with high and standard intensity VKAs however.

 

NIHR Signal: The blood-thinner apixaban is less likely to cause major bleeding than warfarin

National Institute for Health Research Signal

Expert commentary is provided for a cohort study which found a lower rate of major bleeding with apixaban vs warfarin (HR 0.66, 95%CI 0.54- 0.79). Residual confounding is likely however, and these data should only be considered supportive of randomised trials, not replacing them.

 

Venous Thromboembolism: Advances in Diagnosis and Treatment

Journal of the American Medical Association

Amongst other points, this review of 32 studies from the US perspective notes that the introduction of direct oral anticoagulants has allowed for a simplified treatment and has made extended secondary prevention more acceptable.

 

European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism

European Heart Journal

A patent foramen ovale is implicated in pathogenesis of a number of medical conditions; however, the subject remains controversial and no official statements have been published. This paper reviews available trial evidence and defines principles needed to guide decision making.

 

Association of Genetic Variants With Warfarin-Associated Bleeding Among Patients of African Descent

Journal of the American Medical Association

This case-control study (n=215) in patients of African descent found that 4 single nucleotide polymorphisms on chromosome 6 were associated with an increased risk of major bleeding at INR<4. Authors highlight that validations in an independent prospective cohort is required.

 

Spontaneous splenic rupture due to rivaroxaban

Drug and Therapeutics Bulletin

This summary describes the fifth case report of of spontaneous splenic rupture of a patient treated with rivaroxaban and highlights that this has also been reported with apixaban and dabigatran. It suggests key learning points, including checking for drug interactions.

 

 

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