Monday, 20 January 2014 00:00

Anticoagulation news items. Week commencing 20th January 2014

 

Revised SPC for diclofenac.
The SPCs have been updated with warnings about the CV risks of diclofenac, which may increase with dose and duration of exposure. Patients with significant risk factors for CV events should only be treated with diclofenac after careful consideration; and reviewed regularly.
http://www.medicines.org.uk/emc/medicine/1342/SPC/Voltarol%20Tablets/

Prasugrel (Efient): increased risk of bleeding – information on timing of loading dose.

New trial data are available on timing of prasugrel loading dose when used in patients with unstable angina or NSTEMI. In these patients, when coronary angiography is done within 48 hours after admission, loading dose should only be given at time of PCI to minimise bleeding risk.
http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON364156

Warfarin use and the risk for stroke and bleeding in patients undergoing dialysis.
This Canadian retrospective cohort study (n=1626 dialysis, n=204,210 non-dialysis, ≥65 years, admitted to hospital with AF) found that in patients with AF undergoing dialysis, warfarin was not beneficial in reducing stroke risk but was associated with a higher bleeding risk.
http://circ.ahajournals.org/content/early/2014/01/22/CIRCULATIONAHA.113.004777.abstract


Combined hormonal contraceptives: Europe-wide review confirms the risk of thromboembolism is small and agrees updated information to reflect the latest evidence.
The Europe-wide review concluded that the risk of blood clots with all CHCs is small and the benefits of any CHC far outweigh the risk of serious side effects. There is good evidence that the risk of VTE may vary between products, depending on the progestogen.
https://www.cas.dh.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=102106

Optimal duration of dual anti-platelet therapy after drug-eluting stent implantation: A randomised, controlled trial.
This study (n=5045) reported that at 24 months following randomisation, death from cardiac causes, MI or stroke did not differ significantly between the two arms—57 aspirin-alone patients (2.4%) and 61 aspirin/clopidogrel patients (2.6%) (HR 0.94; 95% CI 0.66–1.35; P=0.75).
http://circ.ahajournals.org/content/129/3/304.abstract

Primary prophylaxis for venous thromboembolism in people undergoing major amputation of the lower extremity .
This review notes that as only two studies were included, each comparing different interventions, there is insufficient evidence to make any conclusions about the most effective thromboprophylaxis regimen in patients undergoing lower limb amputation.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010525.pub2/full

Associations with anticoagulation: a cross-sectional registry-based analysis of stroke survivors with atrial fibrillation.
This cross-sectional analysis (n=3429) found on multivariate analysis, older age (OR 0.97, 95% CI 0.96–0.98) and higher deprivation scores (OR 0.59, 0.57–0.76) were independently associated with non-prescription of vitamin K antagonists.
http://heart.bmj.com/content/early/2014/01/23/heartjnl-2013-305267.abstract

 

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