Items filtered by date: December 2018

Clopidogrel plus aspirin versus aspirin alone for acute minor ischaemic stroke or high risk transient ischaemic attack: systematic review and meta-analysis

British Medical Journal

Review of 3 RCTs (n=10,447) found that compared with aspirin alone clopidogrel plus aspirin, started within 24 hours of symptom onset, reduced the risk of non-fatal recurrent stroke (RR 0.70, 95% CI 0.61-0.80, absolute risk reduction 1.9%).

 

Graduated compression stockings for prevention of deep vein thrombosis

Cochrane Database of Systematic Reviews

Review of data from 20 high-quality RCTs (n=1681) concludes graduated compression stockings are effective in reducing the risk of DVT in hospitalised patients who have undergone general and orthopaedic surgery, with or without other methods of background thromboprophylaxis.

 

Rutosides for treatment of post‐thrombotic syndrome

Cochrane Database of Systematic Reviews

Review of 3 low quality RCTs (n=233) concludes rutosides are not superior to placebo or elastic compression stockings for post‐thrombotic syndrome, characterised by pain, swelling, and skin changes in affected limb. Rutosides are a group of compounds derived from horse chestnut.

 

NIHR Signal: The best dose of aspirin for cardiovascular protection may depend on body weight

National Institute for Health Research Signal

Expert commentary is provided for a review of 13 RCTs which found that low dose aspirin was effective for secondary prevention in those <70kg, but not >70kg. The findings reinforce the importance of tailoring the aspirin dose to a patient's characteristics, including weight.

 

Efficacy and safety of aspirin for primary prevention of cardiovascular events: a meta-analysis and trial sequential analysis of randomized controlled trials

European Heart Journal

Analysis of 11 trials (n=157,248) found at mean follow-up of 6.6 years, aspirin was not linked to lower incidence of all-cause mortality but to increased incidence of major bleeding (RR 1.47, 95% CI 1.31–1.65; p< 0.0001) and intracranial haemorrhage (1.33, 1.13–1.58; p = 0.001).

 

Janssen submits supplemental new drug application to US FDA for rivaroxaban to prevent venous thromboembolism in acute medically ill patients

Biospace Inc.

Application is based on data from phase 3 MAGELLAN and MARINER trials. MAGELLAN met its co-primary endpoints, demonstrating non-inferiority to enoxaparin in short-term (10 days) and superiority in long-term (35 days) use, while MARINER demonstrated reduction in symptomatic VTE.

 

Effectiveness and safety of 110 or 150 mg dabigatran vs. vitamin K antagonists in nonvalvular atrial fibrillation

British Journal of Clinical Pharmacology

French new-users cohort study (n=14,442) reported that dabigatran at either dose was associated with less major bleeding, stroke and systemic embolism and all-cause mortality than matched VKA-treated patients.

 

Effectiveness and safety of apixaban versus rivaroxaban for prevention of recurrent venous thromboembolism and adverse bleeding events in patients with venous thromboembolism: a retrospective population-based cohort analysis

The Lancet

US database study (3091 apixaban users and 12,163 rivaroxaban users) reported that use of apixaban vs rivaroxaban was associated with decreased risk of recurrent VTE (HR 0.37; 95% CI 0.24–0.55]; p<0.0001) and major bleeding events (0.54; 0.37–0.82; p=0.0031).

 

MI risk associated with naproxen and diclofenac in spondyloarthritis: DTB Select summary

Drug and Therapeutics Bulletin

Summary and context is provided for analysis of the incidence of myocardial infarction in people with spondylarthritis and osteoarthritis treated with NSAIDs which provides further evidence that diclofenac is associated with a higher risk than naproxen.

 

Comparative safety and effectiveness of direct oral anticoagulants in patients with atrial fibrillation in clinical practice in Scotland

British Journal of Clinical Pharmacology

Retrospective cohort study (n=14,577) found all DOACs were similarly effective in preventing stroke, systemic embolism or CV death, while patients on rivaroxaban showed highest bleeding risks.Observed differences in risks of all‐cause mortality, MI and PE warrant further research.

 

 

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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In use product safety assessment report for enoxaparin biosimilars (INHIXA and AROVI)

Specialist Pharmacy Service

This assessment on Inhixa and Arovi (enoxaparin biosimilars) describes the in-use medication safety considerations resultant from the products' presentation or other pre-defined characteristics. Potential next steps and mitigation actions are suggested.

 

Cyclin-Dependent Kinase Inhibitor–Associated Thromboembolism

JAMA Oncology

An overview of the evidence that this drug class (of which palbociclib is the first in class) is associated with an increased incidence of thromboembolism. NICE support the use of palbociclib for use within its marketing authorisation.

 

 

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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Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery

Cochrane Database of Systematic Reviews

Review of 7 RCTs (n=1728) concludes prolonged thromboprophylaxis (≥14 days) with LMWH significantly reduces the risk of VTE compared to thromboprophylaxis during hospital admittance only, without increasing bleeding complications after major abdominal or pelvic surgery.

 

Major Bleeding Rates in Atrial Fibrillation Patients on Single, Dual, or Triple Antithrombotic Therapy: Results from a Nationwide Danish Cohort Study

Circulation

Study (n=272,315) found triple therapy linked to high rates of major bleeding vs. dual or monotherapy. Very high major bleeding rates occurred among patients on triple therapy aged > 90 years or with CHA2DS2-VASc > 6 or with a history of major bleeding.

 

Association of Oral Anticoagulants and Proton Pump Inhibitor Co-therapy With Hospitalization for Upper Gastrointestinal Tract Bleeding

Journal of the American Medical Association

Retrospective study found during 754,389 person-years of anticoagulation with apixaban, dabigatran, rivaroxaban [RV], and warfarin, risk of hospitalisation for upper GI bleeding was highest for RV. PPI cotherapy (264,447 person-years) was linked to lower overall GI bleeding risk.

 

Apixaban to Prevent Venous Thromboembolism in Patients with Cancer

New England Journal of Medicine

RCT (n=574) found apixaban (2.5mg BD) resulted in lower rate of venous thromboembolism vs. placebo in intermediate/high-risk ambulatory patients with cancer starting chemo (12 [4.2%] vs. 28 [10.2%]; HR 0.41; 95% CI, 0.26-0.65; p<0.001) but higher rates of major bleeding episodes.

 

Conference report: positive results for emicizumab for paediatric haemophilia A

Biospace Inc.

Primary analysis of the HAVEN 2 study (n=85) has found that once-weekly emicizumab dosing showed a 99% reduction in treated bleeds compared to prior treatment with bypassing agents.

 

 

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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