Friday, 05 June 2015 20:31

Anticoagulation news items. Week commencing 1st June 2015

Why do electronic health records reveal oral anticoagulant prescription after haemorrhagic stroke?

British Journal of Clinical Pharmacology

There were 134 (1.2%) subjects with electronic health records documenting previous haemorrhagic stroke (HS) prescribed warfarin during a trial. Researchers found that in ~50% patients, stroke event was miscoded as HS when physician-reported diagnosis was of cerebral infarction.

 

Association between edoxaban dose, concentration, anti-Factor Xa activity, and outcomes: an analysis of data from the randomised, double-blind ENGAGE AF-TIMI 48 trial

The Lancet

This study (n=21,105) found tailoring dose of edoxaban on basis of clinical factors alone prevents excess drug levels and helps to optimise risk of ischaemic and bleeding events. Data also showed that therapeutic window for edoxaban is narrower for major bleeding than thromboembolism.

 

Genetics and the clinical response to warfarin and edoxaban: findings from the randomised, double-blind ENGAGE AF-TIMI 48 trial

The Lancet

Analysis of 4833 subjects taking warfarin found that CYP2C9 and VKORC1 genotypes identify patients who are more likely to experience early bleeding with warfarin and who derive a greater early safety benefit from edoxaban compared with warfarin during first 90 days.

 

Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism- technology appraisal guidance [TA341]

National Institute for Health and Care Excellence

Guidance recommends apixaban, within its marketing authorisation, as an option for treating and for preventing recurrent deep vein thrombosis and pulmonary embolism in adults.

 

Early Medication Nonadherence After Acute Myocardial Infarction

Circulation

Analysis of 7425 acute MI patients treated with PCI at 216 US hospitals found that a substantial proportion report suboptimal adherence to prescribed medications, soon after MI. Moderate and low adherence was reported in 25% and 4% of patients, respectively, at 6 weeks post MI.

 

Non-vitamin K antagonist oral anticoagulants and major bleeding-related fatality in patients with atrial fibrillation and venous thromboembolism: a systematic review and meta-analysis

European Heart Journal

Meta-analysis found NOACs (apixaban, dabigatran, edoxaban, rivaroxaban) decrease risk of fatal bleeding by 47%, case fatality due to major bleeding by 32% and all-cause mortality after a bleeding event by 43% vs. vitamin K antagonists.

 

Progress in Intravenous Thrombolytic Therapy for Acute Stroke

JAMA Neurology

This review traces the development of IV thrombolysis to date, considers the shortcomings of alteplase, and examines alternative thrombolytic approaches currently in the pipeline, including the role of neuroimaging and the possibility of combination therapies.

 

 

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