Thrombolysis for acute deep vein thrombosis

Cochrane Database of Systematic Reviews

Evidence suggests that systemic administration and catheter-directed thrombolysis have similar effectiveness. Strict eligibility criteria may be necessary to reduce the risk of bleeding complications, but may limit the applicability of this treatment.

 

Impact of an Interaction Between Clopidogrel and Selective Serotonin Reuptake Inhibitors

American Journal of Cardiology

Findings from large, population-based study in US suggest being treated with CYP2C19-inhibiting SSRI (fluoxetine/fluvoxamine) when initiating clopidogrel
may be linked to increased risk of ischaemic events (HR 1.12; 95% CI, 1.01-1.24) vs. those treated with noninhibiting SSRI.

 

Impact of self-funding on patient experience of oral anticoagulation self-monitoring: a qualitative study

BMJ Open

Analysis of 26 interviews noted variable provision of self-monitoring equipment caused resentment and there were worries about cost of test strips. However,
self-funding did mean that interviewees felt a sense of ownership and were determined to persevere to overcome problems.

 

Revised SPC: Sustanon 250, 250mg/ml solution for injection (testosterone propionate, testosterone phenylpropionate, testosterone isocaproate, testosterone decanoate)

electronic Medicines Compendium

Section 4.4 now advises that testosterone should be used with caution in patients with thrombophilia, as there have been post-marketing studies and reports of thrombotic events in these patients during testosterone therapy.

 

US FDA and European Medicines Agency (EMA) accept for a review, a marketing authorisation application for betrixaban

Biospace Inc.

Betrixaban is an oral, once-daily Factor Xa inhibitor anticoagulant, for extended-duration prophylaxis of venous thromboembolism (VTE) in acute
medically ill patients with risk factors for VTE. The application is based on data from the phase III APEX study.

 

 

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

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

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

 

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

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

Von Willebrand’s Disease

New England Journal of Medicine

This is the most common inherited bleeding disorder. Review discusses latest findings on pathophysiology, diagnosis and treatment, which is based on normalising von Willebrand factor and factor VIII levels in case of bleeding or before an intervention.

 

Association between statin use and ischemic stroke or major haemorrhage in patients taking dabigatran for atrial fibrillation

Canadian Medical Association Journal

Results from two population based nested case control studies of over 45,000 patients show that simvastatin and lovastatin, when combined with dabigatran
etexilate, increased the risk of major haemorrhage, but not ischaemic stroke.

 

 

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

Conference report: Updated results from ongoing phase III RE-VERSE AD study on safety and efficacy of idarucizumab (Praxbind) in urgent situations

Biospace Inc.

In trial of 494 patients who had uncontrolled or life-threatening bleeding or required emergency surgery or an invasive procedure, primary endpoint of reversal of anticoagulant effect of dabigatran with 5g of idarucizumab within 4 hours was 100% Reversal was evident immediately.

 

Recurrent Hospitalization Among Patients With Atrial Fibrillation Undergoing Intracoronary Stenting Treated With 2 Treatment Strategies of Rivaroxaban or a Dose-Adjusted Oral Vitamin K Antagonist Treatment Strategy

Circulation

Study (n=2124) found either rivaroxaban 15 mg OD+P2Y12 inhibitor monotherapy or 2.5 mg rivaroxaban BD plus dual antiplatelet therapy (DAPT) was associated with a reduced risk of all-cause mortality/recurrent hospitalisation vs standard-of-care vitamin k antagonist+DAPT.

 

Warfarin utilisation and anticoagulation control in patients with atrial fibrillation and chronic kidney disease

Heart

Study (n=123188) found warfarin use decreased with increasing severity of chronic kidney disease (CKD) (57.2%–46.4%), but was higher in patients on dialysis (62.3%). Proportion of patients with time in range (TIR) ≥60% decreased with CKD severity; 21% on dialysis achieved TIR≥60%.

 

Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI

New England Journal of Medicine

The administration of either low-dose rivaroxaban (R)+P2Y12 inhibitor for 12 months or very-low-dose R+DAPT for 1, 6, or 12 months was associated with a
lower rate of clinically significant bleeding than was standard therapy with a vit K antagonist+DAPT for 1, 6, or 12 months.

 

Under-prescribing of Prevention Drugs and Primary Prevention of Stroke and Transient Ischaemic Attack in UK General Practice: A Retrospective Analysis

PLOS Medicine

UK study (n=29043) found >50% of people eligible for lipid-lowering, anticoagulant, or antihypertensive drugs were not prescribed them prior to first stroke/TIA. The authors estimate that around 12000 first strokes could be prevented/year annually through optimal prescribing.

 

Extended-Duration Betrixaban Reduces the Risk of Stroke Versus Standard-Dose Enoxaparin Among Hospitalized Medically Ill Patients: An APEX Trial Substudy (Acute Medically Ill Venous Thromboembolism Prevention With Extended Duration Betrixaban)

Circulation

This study (n=7513) reports that there were fewer all-cause strokes (0.54% v 0.97%; RR=0.56; P=0.032) and ischaemic strokes (0.48% v 0.91%; RR=0.53; P=0.026) among patients treated with betrixaban v enoxaparin through 77 days of follow-up.

 

Trade-off of myocardial infarction vs. bleeding types on mortality after acute coronary syndrome: lessons from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) randomized trial

European Heart Journal

Analysis of the TRACER trial (n=12,944) found that MI was associated with a greater risk of mortality compared with Bleeding Academic Research Consortium (BARC) 2 and 3a bleeding; a similar risk of mortality to BARC 3c bleeding; and a lower risk of mortality than BARC 3c bleeding.

 

Ticagrelor versus Clopidogrel in Symptomatic Peripheral Artery Disease

New England Journal of Medicine

RCT (n=13,885) found that ticagrelor is not superior to clopidogrel for reducing cardiovascular events (10.8% vs 10.6%, HR 1.02, 95% CI 0.92-1.13). Major
bleeding occurred at similar rates (1.6% in both groups, HR 1.10, 95% CI 0.84-1.43).

 

CHMP issues positive opinion for lonoctocog alfa (Afstyla) for treatment and prophylaxis of bleeding in patients with haemophilia A

European Medicines Agency

Lonoctocog alfa is a single-chain recombinant human factor VIII product. It is proposed that the market authorisation extends to use in all age groups.

 

 

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

Association of Traditional Cardiovascular Risk Factors with Venous Thromboembolism: An Individual Participant Data Meta-analysis of Prospective Studies

Circulation

Meta-analysis (9 studies, n=255,865 with 4910 VTE events) found that apart from the association of cigarette smoking with provoked VTE, modifiable traditional CVD risk factors are not associated with increased risk. Higher systolic blood pressure was inversely associated with VTE.

 

Anticoagulant therapy for symptomatic calf deep vein thrombosis (CACTUS): a randomised, double-blind, placebo-controlled trial

The Lancet

This RCT (n=152) showed no significant difference between patients receiving nadroparin v placebo in the composite primary outcome-composite measure of
extension of calf DVT to proximal veins, contralateral proximal DVT and symptomatic PE at day 42 (3% vs 5% respectively, p=0.54).

 

 

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

Short term versus long term dual antiplatelet therapy after implantation of drug eluting stent in patients with or without diabetes: systematic review and meta-analysis of individual participant data from randomised trials

British Medical Journal

Review (n=11,473) found long term (12 months) dual antiplatelet therapy (DAPT) did not reduce risk of major adverse cardiac events vs. short term DAPT (≤6 months) but increased risk of bleeding among patients with stents with or without diabetes.

 

Association between delivery methods for red blood cell transfusion and the risk of venous thromboembolism: a longitudinal study

The Lancet Haematology

Study (n=10604) found transfusion via a multi-lumen PICC is associated with a greater risk of thrombosis than via a peripheral IV catheter (HR 1•96 (95% CI
1•47–2•61; p<0•0001) vs. patients not receiving a transfusion, and 1•79 (1•09–2•95; p=0•022) vs. peripheral IV line.

 

Genetic Polymorphisms and Clopidogrel Efficacy for Acute Ischemic Stroke or Transient Ischemic Attack: A Systematic Review and Meta-analysis

Circulation

Review (15 studies, 4762 patients) found carriers of CYP2C19 loss-of-function alleles (*2, *3 and/or *8) were at increased risk of stroke vs non-carriers among patients with ischemic stroke/TIA treated with clopidogrel (12.0 vs. 5.8%; RR 1.92, 95% CI: 1.57-2.35; p<0.001).

 

Adverse events in trial for haemophilia drug, ACE910

Reuters Health

Four patients have suffered serious adverse events relating to thrombosis/ blood clots in a trial of ACE910. ACE910 is a recombinant bispecific monoclonal
antibody which simultaneously binds factor IXa and X, exerting the same function as factor VIII.

 

Wide Variation in Reported Rates of Stroke Across Cohorts of Patients with Atrial Fibrillation

Circulation

This review (34 studies) reports a variation in reported stroke rates in different cohorts of patients with AF showing that CHA2DS2-VASc scores do not
correspond to fixed absolute stroke rates; a net clinical benefit for anticoagulating patients with score 1 or 2 was not observed.

 

 

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

Management of antithrombotic therapy after bleeding in patients with coronary artery disease and/or atrial fibrillation: expert consensus paper of the European Society of Cardiology Working Group on Thrombosis

European Heart Journal

While waiting for observational and randomised data to accrue, this consensus paper offers a European perspective on managing antithrombotic therapy after
bleeding in patients with coronary artery disease and/or AF, including which drugs to stop, which to restart, and when.

 

Patterns of antiplatelet drug use after a first myocardial infarction during a 10-year period

British Journal of Clinical Pharmacology

Trial (n=4690) found persistent users decreased from 84.0% at 1-year to 32.8% at 10 years for any antiplatelet [AP: 77.3% to 27.5% for aspirin; 39.0% to 6.4% for clopidogrel at 6 years]. Most nonpersistent users restarted, leading to 89.3% overall AP users at 10 years post MI.

 

Medicines Optimisation in Atrial Fibrillation

Specialist Pharmacy Service

First section of this document shows how to use nationally available data to build picture of care and assess quality of AF management for any locality. Second
section provides short review protocol for patients on AF register which can be used to optimise their anticoagulation.

 

Non-major bleeding with apixaban versus warfarin in patients with atrial fibrillation

Heart

In this RCT (n=18,140) non-major bleeding was reported less frequently with apixaban (6.4/100 patient-years) than warfarin (9.4/100 patient-years) (adjusted HR 0.69, 95% CI 0.63 to 0.75) and was associated with fewer adverse outcomes including mortality and subsequent major bleed.

 

Conference report: Two real-world studies confirm positive efficacy and safety profile of rivaroxaban taken for longer than 3 months for venous thromboembolism (VTE)

Biospace Inc.

At 6 months, recurrent VTE occurred in 1.07% of people in the continued cohort and 2.10% in the discontinued cohort (p<0.05) whilst major bleeding occurred in 0.79% and 0.72% respectively (p>0.05). Similar findings were reported at 12 months.

 

Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery

New England Journal of Medicine

Study (n=4631) found no significant difference in death/thrombotic complications within 30 days of surgery between tranexamic acid and placebo (16.7% vs.
18.1%, respectively). Tranexamic acid was associated with a lower risk of bleeding vs placebo.

 

 

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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