Saturday, 06 February 2016 09:53

Anticoagulation news items. Weeks commencing 1st February 2016

Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis (CaVenT): 5-year follow-up results of an open-label, randomised controlled trial

The Lancet Haematology

Additional catheter-directed thrombolysis resulted in a persistent and increased clinical benefit vs. control during follow-up for up to 5 years, supporting use of this intervention in patients with extensive proximal DVT. However, it did not lead to better quality of life.


Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 1

European Heart Journal

The following scenarios are covered: stable CAD/PVD; cardioversion, ablation and anti-arrhythmics; mechanical valves, patients with time in therapeutic range of >70% on warfarin; patients with single stroke risk factor; and patients with a single first episode of paroxysmal AF.


Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 2

European Heart Journal

The following scenarios are covered: post CVA/TIA, acute stroke requiring thrombolysis/thrombectomy, initiating/restarting treatment after CVA/TIA, dialysis, the elderly, high risk of GI bleeding, hypertension, adherence and compliance.


Pfizer issues oral anticoagulants toolkit to support delivery of Medicines Use Reviews (MURs) and the New Medicine Service (NMS)

Pharmaceutical Services Negotiating Committee

The PSNC and Pharmacy Voice have endorsed this toolkit, hard copies of which are available to order from the Access Pfizer website (need to register on website and have an Alliance Healthcare account number or Pfizer customer account number).


Nonaspirin Nonsteroidal Anti-Inflammatory Drugs and Risk of Hemorrhagic Stroke: A Systematic Review and Meta-Analysis of Observational Studies


Review of 10 studies did not find link between use of NSAIDs and increased risk of haemorrhagic stroke (pooled RR 1.09; 95% CI, 0.98–1.22), although individually, this risk was modestly elevated in diclofenac and meloxicam users (1.27, 1.02–1.59 and 1.2, 1.08–1.50, respectively).


Summary of antidotes to NOACs (inlcuding those currently in development) which could impact NOAC use in the future

London Medicines Evaluation Network

This briefing aims to provide an update on idarucizumab (launched), andexanet alpha (potential launch 2017), and aripazine (phase 2 studies), including the evidence base underpinning their use as antidotes to NOACs.


Call for independent review of ROCKET-AF trial of rivaroxaban and Bayer’s response

British Medical Journal

There is a call for an independent investigation into the ROCKET-AF trial underpinning use of rivaroxaban to prevent ischaemic stroke in non-valvular AF after a BMJ investigation found defective point of care INR device was used in warfarin arm of trial.


Impact of pharmacy care upon adherence to cardiovascular medicines: a feasibility pilot controlled trial

European Journal of Hospital Pharmacy

This study of 71 patients randomised to receive community pharmacy interviews (face-to-face or phone consultation) for 6 months after discharge following acute treatment for a coronary event showed statistically significantly improved adherence in the intervention group.


Randomized Phase III Trial of Standard Therapy Plus Low Molecular Weight Heparin in Patients With Lung Cancer: FRAGMATIC Trial

Journal of Clinical Oncology

Data from this open-label RCT (n=2,202) show that these heparins do not improve overall survival or metastasis-free survival in lung cancer patients, although there was a statistically significant reduction in VTE (at the cost of increased clinically relevant non-major bleeding).


A review of sex-specific benefits and risks of antithrombotic therapy in acute coronary syndrome (ACS)

European Heart Journal

An overview of current data examining sex differences in the use of, and outcomes related to, antithrombotic therapy for patients with ACS, concludes that antithrombotic therapies for acute MI are similar in efficacy in males & females, but females are at higher risk of bleeding.


Antifibrinolytic therapy for preventing oral bleeding in patients with haemophilia or Von Willebrand disease undergoing minor oral surgery or dental extractions

Cochrane Database of Systematic Reviews

Despite discovery of a beneficial effect of systemically administered tranexamic acid and epsilon aminocaproic acid in preventing postop bleeding, the limited number of RCTs do not provide definite evidence of efficacy of antifibrinolytic therapy in this setting.


Mobile Telephone Text Messaging for Medication Adherence in Chronic Disease A Meta-analysis

JAMA Internal Medicine

According to this meta-analysis, mobile phone text messaging approximately doubles the odds of medication adherence. This increase translates into adherence rates improving from 50% (assuming this baseline rate in patients with chronic disease) to 67.8% (absolute increase 17.8%).


Acute Limb Ischemia and Outcomes With Vorapaxar in Patients with Peripheral Artery Disease: Results From TRA2°P-TIMI 50


This RCT (n=3,787) of patients with symptomatic peripheral artery disease found that vorapaxar reduced total acute limb ischaemia events (ALI) events (94 vs 56, HR=0.59, 95% CI= 0.38-0.93) and first ALI events (HR 0.58, 95% CI= 0.39-0.86).


European CHMP adopts positive opinion for factor X (Coagadex) for the treatment and prophylaxis of bleeding episodes and for perioperative management in patients with hereditary factor X deficiency

European Medicines Agency

Factor X, an antihaemorrhagic, works as replacement therapy and temporarily increases plasma levels of factor X, helping to prevent and control bleeding. Factor X has orphan status and is being reviewed under accelerated assessment.



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: