Friday, 19 February 2021 21:19

Anticoagulation news items. Week commencing 15th February 2021

Revised SPC: Plavix (clopidogrel) 300 mg film-coated tablets

electronic Medicines compendium
SPC have been updated with licence extension for use in combination with aspirin in adult patients with moderate to high-risk transient ischaemic attack (ABCD2-[1] score ≥4) or minor ischaemic stroke (NIHSS-[2] ≤3) within 24 hours of an event.

 

Comparative effectiveness of oral anticoagulants in everyday practice

Heart
Registry study (n=25,551) found DOACs were associated with a lower risk of all-cause mortality vs VKAs (3.6 vs 4.8 per 100 patient years, HR 0.79, 95%CI 0.70-0.89) and major bleeding (1.0 vs 1.4, 0.77, 0.61-0.98) with similar risk of non-haemorrhagic stroke or systemic embolism.

 

Comparison of the Efficacy and Safety Outcomes of Edoxaban in 8040 Women Versus 13 065 Men With Atrial Fibrillation in the ENGAGE AF-TIMI 48 Trial

Circulation
Review of this study found that although pretreatment endogenous factor Xa activity was significantly higher in women than in men, treatment with edoxaban resulted in eventual similar endogenous factor Xa activity, and the efficacy profile was similar between sexes.

 

Prediction models for recurrence and bleeding in patients with venous thromboembolism: A systematic review and critical appraisal

Thombosis Research
Review (18 studies) findings do not support use of prediction models to weigh risks for recurrence and bleeding when deciding to anticoagulated patients after initial treatment of VTE. Important methodological limitations and insufficient predictive accuracy were found.

 

Direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic review

BMJ Open
Review of 33 studies (1 RCT, 5 observational cohorts and 27 case series, total n=594) concludes that the evidence for DOACs in cerebral venous thrombosis is limited, but suggests sufficient safety and efficacy vs standard therapy. Further rigorous trials are needed.

 

Prophylactic anticoagulation for patients in hospital with covid-19

British Medical Journal
This editorial discusses research to date on thromboprophylaxis in patients admitted to hospital with Covid-19 including the interim results from three separate RCTs (anticoagulation arm of REMAP-CAP, ATTACC, and ACTIV4a), widely available before peer-review.

 

Primary prophylaxis for venous thromboembolism in ambulatory cancer patients receiving chemotherapy

Cochrane Database of Systematic Reviews
This updated review (32 RCTs [6 new]; n=15,678) found LMWH reduce, and direct factor Xa inhibitors may reduce, incidence of symptomatic VTE; both likely increase risk of major bleeding. Evidence for use of thromboprophylaxis with other anticoagulants is limited.

 

 

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