Items filtered by date: December 2016

Prothrombin complex concentrates versus fresh frozen plasma for warfarin reversal

Thrombosis and Haemostasis

Review found prothrombin complex concentrate (PCC) normalises INR more often and faster than fresh frozen plasma in warfarin-treated patients with major
bleeding/need for urgent surgery/ invasive procedure. PCCs were also less likely to cause volume overload or heart failure.

 

NIHR Signal: Long-haul flyers could reduce risk of leg blood clots with compression stockings

National Institute for Health Research Signal

This is an expert commentary of a Cochrane review which found that airline passengers could reduce their risk of getting a deep vein thrombosis by wearing
compression stockings, even if they are at low risk.

 

NIHR Signal: People prefer shorter compression stockings to prevent blood clots

National Institute for Health Research Signal

This is an expert commentary of a systematic review which found people having surgery prefer wearing knee length to thigh length compression stockings to prevent deep vein thrombosis, and are more likely to wear knee length stockings correctly and for the recommended time.

 

 

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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Patients' perceptions and experiences of the prevention of hospital-acquired thrombosis: a qualitative study

BMJ Open

Semi-structured interviews with 31 patients requiring venous thromboembolism (VTE) prophylaxis following recent hospital admission in UK found good adherence to heparin and poor adherence to elastic compression stockings, as well as limited knowledge of signs and symptoms of VTE.

 

Should all anticoagulated patients with head injury receive a CT scan? Decision-analysis modelling of an observational cohort

BMJ Open

Analysis of data on 3566 adults from 33 A+Es found CT scanning for all anticoagulated patients with head injury is not cost-effective (£94,895/QALY gained) vs. selective scanning based on guidelines recommending scanning only for those with evidence of traumatic brain injury.

 

Thrombus Aspiration in ST Elevation Myocardial Infarction: An Individual Patient Meta-analysis

Circulation

Review of 3 RCTs (n=19,047) found no difference in CV death at 30 days for thrombus aspiration plus PCI vs PCI alone, however in those with high thrombus burden (TIMI thrombus grade ≥3) thrombus aspiration was associated with less CV death (2.5% vs 3.1%, HR 0.80; 95%CI 0.65-0.98).

 

 

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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Pentasaccharides for the prevention of venous thromboembolism

Cochrane Database of Systematic Reviews

Review (n=21004) found moderate to high quality evidence that fondaparinux is effective for short term prevention of VTE vs. placebo. Low to moderate quality evidence shows that fondaparinux is effective for short-term prevention of VTE vs. low molecular weight heparin.

 

A Critical Appraisal of Aspirin in Secondary Prevention: Is Less More?

Circulation

This article critically reviews the available evidence for aspirin use after ACS and PCI and discusses the scientific rational for ongoing studies testing the risks and benefits of omission or early discontinuation of aspirin in favor of P2Y12 inhibitor monotherapy.

 

Development and validation of risk prediction model for venous thromboembolism in postpartum women: multinational cohort study

British Medical Journal

This cohort study based on 433 353 deliveries in England and 662 387 in Sweden has been used to develop a new prediction model that quantifies absolute risk of postpartum VTE based on clinical variables in order to serve as the basis for decisions on obstetric thromboprophylaxis.

 

Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism

Cochrane Database of Systematic Reviews

Moderate quality evidence suggests that combining IPC and pharmacological prophylaxis, compared with either alone, decreases the incidence of DVT when compared to compression, and incidence of PE when compared to anticoagulation.

 

Thromboprophylaxis after Knee Arthroscopy and Lower-Leg Casting

New England Journal of Medicine

Two open label RCTs (n=1,543; n=1,519) found no significant difference in the rate of VTE for 8 days prophylactic LMWH vs no thromboprophylaxis post arthroscopy or prophylactic LMWH or no thromboprophylaxis after cast treatment.

 

 

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

Compression stockings for preventing deep vein thrombosis in airline passengers

Cochrane Database of Systematic Reviews

Review found high-quality evidence that airline passengers can expect a substantial reduction in the incidence of symptomless DVT and low-quality evidence that leg oedema is reduced if passengers wear compression stockings.

 

Antiplatelet versus anticoagulation treatment for patients with heart failure in sinus rhythm

Cochrane Database of Systematic Reviews

Evidence suggests neither anticoagulation (warfarin) nor antiplatelet therapy (aspirin) is better for mortality in systolic heart failure with sinus rhythm
(high quality evidence for all-cause mortality, moderate quality evidence for non-fatal CV and major bleeding events).

 

Testosterone treatment and risk of venous thromboembolism: population based case-control study

British Medical Journal

UK study (n=19 215 DVT/PE; 909,530 age matched controls) found starting testosterone linked to increased venous thromboembolism risk which peaked within 6 months (rate ratio 1.63; 95% CI, 1.12-2.37 corresponding to 10 additional cases above base rate) and declined thereafter.

 

Hormonal Contraception and Risk of Thromboembolism in Women With Diabetes

Diabetes Care

Study (146,080 women, 3,012 thromboembolic events) found rates of thromboembolism were highest among women on the contraceptive patch (16 per 1,000 woman-years) and lowest with intrauterine (6 per 1,000 woman-years) and subdermal (0 per 163 woman-years) contraceptives.

 

Optimal duration of dual antiplatelet therapy after acute coronary syndromes and coronary stenting

Heart

This article provides an overview of the evidence, current guidelines' recommendations and future perspectives on dual antiplatelet therapy (DAPT)
duration after an ACS and after coronary stenting. It proposes an algorithm of optimal duration of DAPT in these settings.

 

 

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