Cangrelor for reducing atherothrombotic events in people undergoing percutaneous coronary intervention or awaiting surgery requiring interruption of anti platelet therapy (terminated appraisal) – technology appraisal guidance (TA351)

National Institute for Health and Care Excellence

NICE is unable to make a recommendation about the use in the NHS of cangrelor for reducing atherothrombotic events in people undergoing PCI or awaiting surgery requiring interruption of anti-platelet therapy because no evidence submission was received from The Medicines Company.

Genotype-guided drug prescribing: a systematic review and meta-analysis of randomized control trials

British Journal of Clinical Pharmacology

This meta-analysis of fifteen studies (n=5688; 19 drugs) reports a statistically significant benefit in favour of genotype-guided warfarin dosing to achieve time in therapeutic INR, resulting in reduction in warfarin-related minor and major bleeding and thromboembolisms.

Oral direct thrombin inhibitors or oral factor Xa inhibitors for the treatment of deep vein thrombosis

Cochrane Database of Systematic Reviews

Review of 11 RCTs (n=27,945) deemed to be of high methodological quality and low risk of bias found that NOACs may be an effective and safe alternative to conventional anticoagulation treatment for acute DVT.

Lixiana®▼(Edoxaban): risk minimisation resources

Daiichi Sankyo

Educational materials have been developed to help manage important risks such as bleeding associated with edoxaban (ED) use. Clinicians should familiarise themselves with these materials before prescribing ED and ensure all patients familiarise themselves with Patient Alert Card.

Primary prophylaxis for venous thromboembolism in patients undergoing cardiac or thoracic surgery

Cochrane Database of Systematic Reviews

There is limited evidence on efficacy and safety. Data for important outcomes such as PE or major bleeding were often lacking. Give uncertainties around benefit-to-risk balance, no conclusions can be drawn and case-by-case risk evaluation of VTE and bleeding remains preferable.

Comparison of the Short-Term Risk of Bleeding and Arterial Thromboembolic Events in Nonvalvular Atrial Fibrillation Patients Newly Treated With Dabigatran or Rivaroxaban versus Vitamin K Antagonists: A French Nationwide Propensity-Matched Cohort Study

Circulation

In this study of 19,713 vitamin K antagonists (VKA), 8,443 dabigatran and 4,651 rivaroxaban new users, no statistically significant difference in bleeding or thromboembolic risk was observed between newer oral anticoagulants users and VKA new users in non-valvular AF patients.

Independent expert review concludes alteplase is safe and effective for use within existing treatment guidelines

Medicines and Healthcare products Regulatory Agency

Following questions about the safety of alteplase, and the methodology used in trials assessing it, an expert working group of the UK's Commission on Human Medicines (CHM) has concluded that alteplase is safe and effective for use up to 4.5 hours after the onset of symptoms.

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