Items filtered by date: August 2016

Rivaroxaban versus warfarin to treat patients with thrombotic antiphospholipid syndrome, with or without systemic lupus erythematosus (RAPS): a randomised, controlled, open-label, phase 2/3, non-inferiority trial

The Lancet Haematology

Results from this RCT (n=110) showed that rivaroxaban and warfarin both inhibit thrombin generation in patients with venous thromboembolism and
antiphospholipid syndrome, and rivaroxaban may be an effective alternative to warfarin in this group of patients.

 

Self‐monitoring and self‐management of oral anticoagulation

Cochrane Database of Systematic Reviews

Review found self-monitoring or self-management can improve quality of oral anticoagulation therapy and reduced thromboembolic events. A reduction in
all-cause mortality was observed in trials of self-management but not in self-monitoring, with no effects on major haemorrhage.

 

New perspectives on atrial fibrillation and stroke

Heart

The current stroke-prevention strategy in embolic and cryptogenic stroke starts with arrhythmia detection, followed by risk stratification and treatment for
those deemed to be at increased risk. This paper reviews recent findings that challenge this practice paradigm.

 

Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial

The Lancet Neurology

In this RCT of 410 patients comparing mechanical thrombectomy (MT) with standard iv thrombolysis (IVT) vs IVT alone, the addition of MT significantly improved functional independence in patients with acute cerebral ischaemia (p=0.028), with no evidence of increased mortality.

 

Andexanet Alfa, factor Xa inhibitor antidote, accepted for review by European Medicines Agency (EMA)

Biospace Inc.

The EMA's Committee for Medicinal Products for Human Use will now begin the centralized review procedure for andexanet alfa, a modified human Factor Xa molecule that acts as a decoy to target and sequester both oral and injectable Factor Xa inhibitors in the blood.

 

 

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

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Impact of Hemoglobin Levels and Anemia on Mortality in Acute Stroke: Analysis of UK Regional Registry Data, Systematic Review, and Meta‐Analysis

Journal of the American Heart Association

Combined data from cohort study (n=8013) and meta-analysis (20 trials) found anaemia on admission was linked to increased risk of mortality in both ischaemic stroke (OR 1.97; 95% CI 1.57–2.47) and haemorrhagic stroke (1.46; 1.23–1.74). Targeted interventions may improve outcomes.

 

Barriers to medication adherence for the secondary prevention of stroke: a qualitative interview study in primary care

British Journal of General Practice

28 survivors of stroke, including 14 accompanying caregivers and five GPs, were interviewed. Medication level barriers included beliefs about medication and
beliefs about how pills work, medication routines, changing medications, and regimen complexity and burden of treatment.

 

Pre-procedural dual antiplatelet therapy in patients undergoing transcatheter aortic valve implantation increases risk of bleeding

Heart

Japanese study (n=540) found dual antiplatelet therapy (DAPT) group had significantly higher incidence of any bleeding vs. single APT group (36.5% vs 27.5%, p=0.049) and no APT (36.5% vs 21.3%, p=0.010). The no APT group did not experience an increased risk of thrombotic events.

 

Lancet series on stroke prevention in atrial fibrillation

The Lancet

Lancet has published a clinical series of 3 papers on AF ahead of annual ESC meeting. AF is estimated to affect 33m people worldwide, but this is likely
underestimated since many do not know they have it until they develop symptoms or present with stroke/systemic thromboembolism.

 

 

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

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Ticagrelor for preventing atherothrombotic events after myocardial infarction: Appraisal consultation document

National Institute for Health and Care Excellence

DRAFT guidance supports use of ticagrelor 60mg, in combination with aspirin, as continuation therapy for preventing atherothrombotic events in people who
have a history of MI and a high risk of developing atherothrombotic events, only if certain criteria are met.

 

Sixteen-year nationwide trends in antithrombotic drug use in Denmark and its correlation with landmark studies

Heart

This paper provides nationwide data on long-term trends in antithrombotic use, noting it has doubled, mainly due to increased antiplatelet use and introduction of DOACs. Authors discuss how trends in use of individual drugs correlate with publication of landmark studies.

 

Occurrence of death and stroke in patients in 47 countries 1 year after presenting with atrial fibrillation: a cohort study

The Lancet

In this study evaluating 15,361 patients of whom 1758 (11%) died within 1 year, heart failure was the most common cause of death (30%) followed by stroke (8%). There were marked unexplained inter-regional variations in the occurrence of stroke and death.

 

Stability of International Normalized Ratios in Patients Taking Long-term Warfarin Therapy

Journal of the American Medical Association

Research letter describes a study of 3749 patients taking warfarin for atrial fibrillation which found that 26% had 80% or more INR values in the 2.0-3.0
range during the first 6 months. Of these patients, 34% continued to have stable INRs over the next 12 months.

 

Triple Oral Antithrombotic Therapy (TOAT) - A Teachable Moment

JAMA Internal Medicine

This review, based on a case vignette, discusses the use of TOAT, highlighting steps to reduce bleeding risk are advisable. These include prescribing a
proton pump inhibitor, using lower doses of antiplatelets, and avoiding high-potency P2Y12 inhibitors prasugrel and ticagrelor.

 

Comparison of Dabigatran versus Warfarin in Patients with Atrial Fibrillation and Valvular Heart Disease: The RE-LY Trial

Circulation

This review of the RE-LY trial found that the presence of VHD (n=3,950) did not influence the comparison of dabigatran with warfarin in terms of major bleed
rates and stroke and systemic embolism rates for both the 110mg and 150mg doses.

 

 

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

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Self-monitoring and self-management of oral anticoagulation therapy

Cochrane Database of Systematic Reviews

Review of 28 RCTs (n=8,950) found a reduction in thromboembolic events in the pooled estimate of self-monitoring or self-management vs standard monitoring (HR, 0.58; 95%CI, 0.45-0.75). No reduction in all-cause mortality or incidence of major or minor haemorrhage was seen.

 

Economic burden of non-malignant blood disorders across Europe: a population-based cost study

The Lancet Haematology

Non-malignant disorders of the blood cost the 31 European countries €11 billion in 2012. Health-care costs accounted for €8 billion (75% of total costs), productivity losses for €2 billion (19%), and informal care for less than €1 billion (6%).

 

Heparin for the prevention of intraventricular haemorrhage in preterm infants

Cochrane Database of Systematic Reviews

There is very limited data on effect of prophylactic heparin on incidence and severity of intraventricular haemorrhage (IVH). Both the identified trials used
heparin in the context of maintaining umbilical line patency and not specifically to prevent germinal matrix IVH.

 

Impact of age on long-term anticoagulation and how gender and monitoring setting affect it: implications for decision making and patient management

British Journal of Clinical Pharmacology

Study (n=2094) found that frequency of warfarin dose changes and INR monitoring events declined until around age 67, then increased as patients got older.

 

Anticoagulation versus antiplatelet or no therapy in patients undergoing bioprosthetic valve implantation: a systematic review and meta-analysis

Heart

In a meta-analysis of 2 randomised and 12 observational studies, there was no benefit of adding a vitamin K antagonist (VKA) with regards to thromboembolism or mortality, versus antiplatelet /no therapy. However, use of a VKA was linked to increased risk of major bleeding.

 

Venous thromboembolism in medical patients during hospitalisation and 3 months after hospitalisation: a prospective observational study

BMJ Open

Australian study (n=986) found 54 (5.5%) developed venous thromboembolism (VTE), of which 25.9% (14/54) had detected VTE post-hospitalisation with increased risk if there was history of VTE, recent surgery and pulmonary conditions, suggesting potential role of thromboprophylaxis.

 

Evaluation of two new NICE indicators to help GPs and CCGs improve identification and management of atrial fibrillation (AF)

National Institute for Health and Care Excellence

In 2017, 30 UK GP practices will test these indicators. GPs will routinely test anyone >65 years for AF and assess how often someone with AF discusses treatment with GP. If these measures are found to improve AF identification/management, they could be rolled out in 2017/18.

 

 

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

Published in News