Friday, 11 January 2019 18:50

Anticoagulation news items. Week commencing 7th January 2019

Thrombolytic therapy for pulmonary embolism

Cochrane Database of Systematic Reviews

Review of 18 RCTs (n=2197) concludes low‐quality evidence shows thrombolytics in addition to heparin reduce death and recurrence of pulmonary embolus following acute pulmonary embolism, compared with heparin alone. The included studies used a variety of thrombolytic drugs.

 

Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases

British Medical Journal

Analysis (n=80 396 matched to 391,494 controls.) found most oral preparations were linked to increased VTE risks. Conjugated equine oestrogens with or without medroxyprogesterone acetate, were linked to highest risks. No increased risk was found for transdermal preparations.

 

Relationship between body mass index and outcomes in patients with atrial fibrillation treated with edoxaban or warfarin in the ENGAGE AF-TIMI 48 trial

European Heart Journal

Review of data from the ENGAGE AF-TIMI 48 trial found that an increased BMI was independently associated with a lower risk of stroke or systemic embolic events (per 5 kg/m2 increase, HR=0.88, p=0.0001), but increased risk of major bleeding (HR 1.06, P = 0.025).

 

Inhaled Tranexamic Acid for Hemoptysis Treatment

Chest

RCT (n=47) found that resolution of hemoptysis within 5 days of admission was observed in more tranexamic acid (TXA) treated vs placebo (96% vs 50%; p< 0.0005). TXA patients also had a shorter hospital stay and required fewer interventional procedures.

 

Effect of Low-Dose Intracoronary Alteplase During Primary Percutaneous Coronary Intervention on Microvascular Obstruction in Patients With Acute Myocardial Infarction: A Randomized Clinical Trial

Journal of the American Medical Association

RCT (n=195) was stopped early due to futility. Among patients with acute STEMI presenting within 6 hours of symptoms, adjunctive low-dose intracoronary alteplase given during the primary percutaneous intervention did not reduce microvascular obstruction vs placebo.

 

Pro‐coagulant haemostatic factors for the prevention and treatment of bleeding in people without haemophilia

Cochrane Database of Systematic Reviews

Review of 31 RCTs (n=2392) found that paucity of good‐quality evidence precludes the drawing of conclusions for clinical practice. Sample sizes of future RCTs would need to be greatly increased to detect a reduction in mortality or thromboembolic events between treatment arms.

 

Uterotonic agents for preventing postpartum haemorrhage: a network meta‐analysis

Cochrane Database of Systematic Reviews

Analysis (196 trials; n=135,559; 7 uterotonic agents) found all agents were generally effective vs. placebo or no treatment. Some oxytocin (OX) combination regimens may have some additional desirable effects vs current standard OX but are linked to significant side effects.

 

Tranexamic acid for patients with nasal haemorrhage (epistaxis)

Cochrane Database of Systematic Reviews

Review of 6 RCTs (n=692) found moderate‐quality evidence that there is probably a reduction in the risk of re‐bleeding with use of either oral or topical tranexamic acid in addition to usual care in adults with epistaxis, compared to placebo with usual care.

 

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