Rivaroxaban Is Associated With Higher Rates of Gastrointestinal Bleeding Than Other Direct Oral Anticoagulants: A Nationwide Propensity Score–Weighted Study

Annals of Internal Medicine
Study (n=2,157) found rates of GI bleeding were higher for rivaroxaban than apixaban (3.2 vs. 2.5 overall events per 100 person-years [HR 1.42; 95% CI 1.04 to 1.93; major bleeding HR 1.50 [1.00 to 2.24]) and dabigatran (similar estimates but including possibility of null effect).

All Wales Medicines Strategy Groups consults on draft guidance on oral anticoagulation for non-valvular atrial fibrillation

All Wales Medicines Strategy Group
This consultation presents a proposed update to the current guidance, following the publication of updated NICE guidance (NG196; published June 2021). The update includes re-positioning DOACs before vitamin K antagonists, and an amendment to the tool for assessing bleeding risk.

Would You Recommend Aspirin to This Patient for Primary Prevention of Atherosclerotic Cardiovascular Disease?

Annals of Internal Medicine
In this article, two clinicians discuss and debate current guidelines on use of aspirin for primary prevention of atherosclerotic vascular disease, the appropriate risk threshold for starting aspirin therapy, and the role of the coronary artery calcium score in decision making.

Reduction in Acute Limb Ischemia with Rivaroxaban versus Placebo in Peripheral Artery Disease after Lower Extremity Revascularization: Insights from VOYAGER PAD

Circulation
Review of VOYAGER PAD study (n=6564) found, in those with prior lower extremity revascularisation, rivaroxaban reduced acute limb ischaemia vs placebo (by 2.6% at 3 years; HR 0.67, 95%CI 0.55 to 0.82) with a benefit starting early (HR 0.45, 0.24 to 0.85 at 30 days after surgery).

Anticoagulant prescribing for atrial fibrillation and risk of incident dementia

Heart
In study of healthcare records from UK CPRD (n=39,200 of whom 1258 had dementia [DM]), use of DOAC for AF was linked to 16% reduction in DM diagnosis vs. Vit K antagonist (HR 0.84, 95% CI: 0.73-0.98) & 26% reduction in incident mild cognitive impairment (0.74, 95% CI: 0.65-0.84).

Effectiveness of therapeutic heparin versus prophylactic heparin on death, mechanical ventilation, or intensive care unit admission in moderately ill patients with covid-19 admitted to hospital: RAPID randomised clinical trial

British Medical Journal
This RCT in hospitalised adults with Covid-19 and increased D-dimer levels (n=465; mean BMI 30.3 kg/m2) found therapeutic dose heparin did not reduce the risk of the primary composite endpoint (16.2% v 21.9% prophylactic dose; OR 0.69, 95% CI 0.43 to 1.10; P=0.12).

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