Prasugrel versus ticagrelor in patients with myocardial infarction undergoing percutaneous coronary intervention

Heart
During 1-year follow-up of 37,990 Swedish patients, prasugrel and ticagrelor were associated with similar efficacy (risk of major adverse cardiac and cerebrovascular events: HR 1.03; 95% CI 0.86 to 1.24) and bleeding risk (2.5% vs 3.2%, adjusted HR 0.92, 95% CI 0.69 to 1.22).

Administering Thrombolysis for Acute Ischemic Stroke in Patients Taking Direct Oral Anticoagulants: To Treat or How to Treat

JAMA Neurology
The authors discuss potential approaches and recommend a tailored approach to select patients taking DOAC with acute ischaemic stroke for thrombolysis by combining clinical and imaging information with anticoagulant activity and use of specific reversal agents only if necessary.

International Society on Thrombosis and Haemostasis (ISTH) statement on the AstraZeneca COVID-19 vaccine and thrombosis

The International Society on Thrombosis and Haemostasis
The ISTH recommends that all eligible adults continue to receive COVID-19 vaccinations, despite the recent decisions by some countries to at least temporarily suspend the use of the AstraZeneca vaccine due to reports of thrombosis.

Diagnosis and Management of Transient Ischemic Attack and Acute Ischemic Stroke: A Review

Journal of the American Medical Association
This review provides an update on management of transient ischaemic attack and acute ischaemic stroke, emphasising advances in use of dual antiplatelet therapy and fibrinolysis vs mechanical thrombectomy for secondary and tertiary prevention.

Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies

The Lancet Neurology
Analysis of 38 hospital-based prospective cohort studies from 18 countries (n=31,550) suggests MICON risk scores, incorporating clinical variables & cerebral microbleeds, offer predictive value for long-term risks of intracranial haemorrhage & ischaemic stroke in this population.

MHRA confirms people should continue to receive COVID-19 vaccine AstraZeneca

Medicines and Healthcare products Regulatory Agency
Following rigorous scientific review of all available data, MHRA said available evidence does not suggest venous thromboembolism is caused by COVID-19 Vaccine AstraZeneca and benefits of the vaccines against COVID-19 continue to outweigh any risks.

COVID-19 Vaccine AstraZeneca: benefits still outweigh the risks despite possible link to rare blood clots with low blood platelets

European Medicines Agency
The European PRAC has concluded its preliminary review of a signal of blood clots in people vaccinated with COVID-19 Vaccine AstraZeneca and confirmed its benefits in combating the still widespread threat of COVID-19 continue to outweigh the risk of side effects.

Effect of Intermediate-Dose vs Standard-Dose Prophylactic Anticoagulation on Thrombotic Events, Extracorporeal Membrane Oxygenation Treatment, or Mortality Among Patients With COVID-19 Admitted to the Intensive Care Unit - The INSPIRATION Randomized Clinical Trial

Journal of the American Medical Association
This study in Iran (n=600; 562 in primary analysis) found no difference between routine use of intermediate dose (enoxaparin 1mg/kg daily) and standard prophylactic anticoagulation (enoxaparin 40mg daily) in terms of the composite primary endpoint (45.7% v 44.1%).

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