Items filtered by date: November 2018

Early Risks of Death, Stroke/Systemic Embolism and Major Bleeding in Patients with Newly Diagnosed Atrial Fibrillation: Results from the GARFIELD-AF Registry

Circulation

Registry study (n=52,014) found an elevated mortality rate in the first month after diagnosis vs the first year (6.8 vs 4.3 100 person years for first month and first year respectively). The elevated 1-month mortality rate was mostly attributable to cardiovascular mortality.

 

Subcutaneous treprostinil for the treatment of severe non-operable chronic thromboembolic pulmonary hypertension (CTREPH): a double-blind, phase 3, randomised controlled trial

The Lancet Respiratory Medicine

RCT (N=105) reported an improvement from baseline in mean 6-min walk distance in the treprostinil high and low dose groups (44·98 m and 4·29 m; p=0·0016). Treprostinil is an investigational prostacyclin analogue that has received orphan drug status in the EU.

 

 

 

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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Efficacy and Safety of Drug-Eluting Stents Optimized for Biocompatibility vs Bare-Metal Stents With a Single Month of Dual Antiplatelet Therapy: A Meta-analysis

JAMA Cardiology

This review of 3 RCTs (n=3943) comparing bare-metal stents (BMSs) to drug-eluting stents (DESs) with shortened duration of dual antiplatelet therapy (one month only) found DES were associated with lower risk of major adverse cardiac events and other adverse outcomes.

 

 

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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The role of plasminogen activators in stroke treatment: fibrinolysis and beyond

The Lancet Neurology

This review describes the pathophysiological effects of plasminogen activators and how, in the future, their non-fibrinolytic functions could be used for the treatment of patients with acute ischaemic and haemorrhagic stroke.

 

Practice guide to dosing of direct acting oral anticoagulants in patients with renal impairment

Specialist Pharmacy Service

This paper, focusing on use of DOACs in patients with atrial fibrillation, discusses the debate regarding the dosing of DOACs in patients with renal impairment and offers some practical advice on selecting the dose in the clinical setting.

 

Management of life threatening bleeds from arteriovenous fistulae and grafts

NHS Improvement

Alert signposts providers to resources produced jointly by British Renal Society and Vascular Access Society of Britain and Ireland to help staff, carers and patients recognise warning signs. Providers are asked to ensure local guidance incorporates advice in these resources.

 

Percutaneous vascular interventions versus intravenous thrombolytic treatment for acute ischaemic stroke

Cochrane Database of Systematic Reviews

Review (4 trials, n=450) found no RCT evidence that percutaneous vascular interventions are superior to intravenous thrombolytic treatment with respect to functional outcome. Quality of evidence was low (outcome assessment was blinded but not treating physician/participants).

 

Performance of the ABC Scores for Assessing the Risk of Stroke or Systemic Embolism and Bleeding in Patients with Atrial Fibrillation in ENGAGE AF-TIMI 48

Circulation

Paper reports that ABC-stroke and ABC-bleeding risk scores which comprise clinical variables and CV biomarkers to estimate risk of stroke/systemic embolic events and bleeding, respectively, were well-calibrated and outperformed the CHA2DS2-VASc and HAS-BLED scores, respectively.

 

Self‐poisoning with 60 tablets of Apixaban, a pharmacokinetics case report

British Journal of Clinical Pharmacology
Apixaban was eliminated following first order elimination with a calculated half‐life of 10.8 h. Anti‐Xa activity seems to be linearly related to concentration up to 4000 μg/ l. This report suggests use of activated charcoal should be effective up to 17 h after a massive intake.

 

 

 

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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Barriers to a software reminder system for risk assessment of stroke in atrial fibrillation: a process evaluation of a cluster randomised trial in general practice

British Journal of General Practice

An evaluation of 23 practices found that an automated risk assessment for stroke in AF and prompting during consultations are feasible and generally acceptable, but did not overcome concerns about frailty and risk of haemorrhage as barriers to anticoagulant uptake.

 

Revised SPCs: Plavix (clopidogrel) 75 and 300mg tablets

electronic Medicines compendium

Insulin autoimmune syndrome has been added to SPCs as an adverse effect (unknown frequency). This can lead to severe hypoglycaemia, particularly in patients with HLA DRA4 subtype (more frequent in the Japanese population).

 

Timing of anticoagulation after recent ischaemic stroke in patients with atrial fibrillation

The Lancet Neurology

This Rapid Review summarises and critically reviews current guidelines and new published data, and gives an overview of ongoing investigator-initiated randomised controlled trials of oral anticoagulation timing after ischaemic stroke associated with atrial fibrillation.

 

 

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 anticoagulant choice on hospitalized bleeding risk when treating cancer-associated venous thromboembolism

Journal of Thrombosis and Haemastasis

This US retrospective study (26,894 people with cancer-associated venous thrombosis), found that the bleeding risk with DOACs was similar to warfarin and low molecular weight heparin. There was however heterogeneity in bleeding risk with DOACs by cancer type.

 

Interventions for Preventing Thromboembolic Events in Patients With Atrial Fibrillation: A Systematic Review

Annals of Internal Medicine

Review of 220 articles aimed to compare the effectiveness of medical and procedural therapies in preventing thromboembolic events and bleeding complications in adults with non-valvular AF. It found DOACs are at least as effective and safe as warfarin for patients.

 

Idarucizumab for Dabigatran Reversal in the Management of Patients with Major Gastrointestinal Bleeding

Circulation

In RE-VERSE AD trial, idarucizumab showed rapid/complete reversal of dabigatran activity in nearly all patients with GI bleeding; complete reversal in 118 of 121 (97.5%) with elevated diluted thrombin time at presentation and 95 of 131 (72.5%) with elevated ecarin clotting time.

 

Rivaroxaban vs warfarin in high-risk patients with antiphospholipid syndrome

Blood

Trial (n=120) was terminated early due to an excess of events in the rivaroxaban group compared to warfarin (7 thromboembolic events; 4 ischemic stroke and 3 myocardial infarction vs. 0 events, respectively). Major bleeding occurred in 4 vs. 2 patients, respectively.

 

 

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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