Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome

Medicines and Healthcare products Regulatory Agency

MHRA advises that DOACs are not recommended in patients with antiphospholipid syndrome, particularly high-risk patients (those who test positive for all 3 antiphospholipid tests — lupus anticoagulant, anticardiolipin antibodies, and anti-beta 2 glycoprotein I antibodies).

Safety and Efficacy of Antithrombotic Strategies in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Network Meta-analysis of Randomized Controlled Trials

JAMA Cardiology

Review of 4 RCTs (n = 10 026) found DOAC plus P2Y12 inhibitor was linked to less bleeding vs. vitamin K antagonists + dual antiplatelets; strategies omitting aspirin caused less bleeding without significant difference in major adverse CV event vs. strategies including aspirin.

Warfarin dose requirement in patients having severe thrombosis or thrombophilia

British Journal of Clinical Pharmacology

Study (n=50) found that currently the most used pharmacogenetics dosing algorithms (IWPC and Gage) underestimate the warfarin dose required for effective anticoagulation in thrombogenic young (age <50 years) patients, particularly those who are at the highest thrombotic risk.

Revised SPC: Brilique (ticagrelor) tablets

electronic Medicines compendium

Thrombotic thrombocytopenic purpura has been added as a potential adverse effect of treatment (frequency unknown).

Ticagrelor Versus Clopidogrel in Patients With STEMI Treated With Fibrinolysis: TREAT Trial

Journal of the American College of Cardiology

Open-label RCT (n=3,799) found that ticagrelor did not significantly reduce the frequency of CV events vs clopidogrel when used after fibrinolytic therapy (combined outcome of CV mortality, MI or stroke = 6.7% vs 7.3% for ticagrelor vs clopidogrel, HR 0.93, 95% CI 0.73-1.18).

Oral anticoagulants in atrial fibrillation with valvular heart disease and bioprosthetic heart valves

European Heart Journal

Network meta-analysis (n=13,574) found that NOACs are superior, vs warfarin, in reducing stroke or systemic embolisation, MI and intracranial haemorrhage in AF and valvular heart disease. Analysis of 280 patients with AF and bioprosthetic heart valve showed similar outcomes.

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:

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