Friday, 17 July 2015 20:10

Anticoagulation news items. Week commencing 13th July 2015

rivaroxaban (Xarelto®)

Scottish Medicines Consortium

The SMC does not recommend use of rivaroxaban (co-administered with aspirin ± clopidogrel or ticlopidine) within NHS Scotland for the prevention of atherothrombotic events in adults after an acute coronary syndrome with elevated cardiac biomarkers.

 

tinzaparin sodium (Innohep®)

Scottish Medicines Consortium

The SMC has accepted tinzaparin for use within NHS Scotland for the extended treatment of symptomatic VTE and prevention of its recurrence in patients with solid tumours. This advice takes account of the benefits of a Patient Access Scheme that improves its cost-effectiveness.

 

Peri-procedural management of patients taking oral anticoagulants

British Medical Journal

This review summarises the pharmacology of oral anticoagulants (OA) relevant to the peri-procedural period, and reported outcomes of peri-procedural management of oral anticoagulants used for therapeutic purposes.

 

Choice of Estimated Glomerular Filtration Rate Equation Impacts Drug-Dosing Recommendations and Risk Stratification in Patients With Chronic Kidney Disease Undergoing Percutaneous Coronary Interventions

Journal of the American College of Cardiology

This study, aimed at identifying which equation is superior in estimating GFR for predicting adverse outcomes after PCI, supports use of CKD-EPI equation for risk stratification and calls for standardisation in estimation of GFR for studies to improve dosage recommendations.

 

Deep vein thrombosis, pulmonary embolism (treatment, secondary prevention) - edoxaban tosylate: final appraisal determination

National Institute for Health and Care Excellence

In DRAFT guidance, NICE recommends edoxaban, within its marketing authorisation, as an option for treating and for preventing recurrent deep vein thrombosis and pulmonary embolism in adults.

 

Intracranial Hemorrhage After Ischemic Stroke: Incidence, Time Trends, and Predictors in a Swedish Nationwide Cohort of 196 765 Patients

Circulation: Cardiovascular Quality and Outcomes

Incidence of intracranial hemorrhage within 1-year after stroke was ≈2%/year at risk, about 15 times higher vs. reference population. Risk increased within first 30 days but decreased thereafter. Thrombolysis, but not increased use of antithrombotics/statins, affected risk.

 

Androgen Deprivation Therapy for Prostate Cancer and the Risk of Venous Thromboembolism

European Urology

Cohort study (n=21,729 of whom 609 hospitalised for VTE) found current (vs. non) use of androgen deprivation therapy was linked to 84% increased relative risk of VTE (incidence rates:10.1 vs 4.8/1000 person-years;HR:1.84;95% CI,1.50–2.26), whereas there was no link with past use.

 

Heparin-Induced Thrombocytopenia

New England Journal of Medicine

Treatment of acute heparin-induced thrombocytopenia (HIT) requires the cessation of heparin and initiation of therapeutic-dose anticoagulation with an alternative agent (argatroban, danaparoid, fondaparinux, or bivalirudin). Warfarin should be avoided in patients with acute HIT.

 

Risk of intracranial haemorrhage in antidepressant users with concurrent use of non-steroidal anti-inflammatory drugs: nationwide propensity score matched study

British Medical Journal

This analysis of a Korean nationwide health insurance database found combined use of antidepressants and NSAIDs was associated with an increased risk of intracranial haemorrhage within 30 days versus use of antidepressants without NSAIDs (hazard ratio 1.6, 95% CI 1.32 to 1.85).

 

Oral anticoagulants for stroke prevention in atrial fibrillation: current status, special situations, and unmet needs

The Lancet
This paper addresses the role of anticoagulation for stroke prevention in AF in the era of NOACs, with a focus on special situations including management in the event of bleeding and around the time of procedures including cardioversion, catheter ablation, and device implantation.

 

Pharmacology of antithrombotic drugs: an assessment of oral antiplatelet and anticoagulant treatments

The Lancet
This paper focuses on the pharmacological properties of the most commonly used oral antithrombotic drugs (aspirin, P2Y12 receptor antagonists, other targets, vitamin K antagonists, and non-VKA anticoagulants).

 

 

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