Friday, 16 March 2018 19:15

Anticoagulation news items. Week commencing 5th and 12th March 2018

Revised SPC: Urokinase products

electronic Medicines compendium

Diluent for further dilution, previously unspecified, is now named as sodium chloride 0.9 % solution for injection. SPC now advises that after reconstitution and further dilution in glucose 5% / 10%, urokinase solution should be used immediately, due to risk of loss in activity.


Effectiveness of new antiplatelets in the prevention of recurrent myocardial infarction


Real-world study (n=1047 cases;2234 controls) found recurrent MI risk is lower with ticagrelor or prasugrel vs clopidogrel;magnitude of which was larger than observed effect in trials: OR 0.65;95% CI 0.52 -0.81 and 0.71;0.53-0.96 vs 0.84 0.77-0.9 and 0.81;0.73- 0.90, respectively.


Imaging is the only way to diagnose blood clots in pregnancy

National Institute for Health Research Signal

An expert commentary is provided on this study which concluded biomarkers, including the D-dimer test were not useful in diagnosing PE and DVT, and imaging tests are therefore required in this population.


6-month versus 12-month or longer dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (SMART-DATE): a randomised, open-label, non-inferiority trial

The Lancet

RCT (n=2,712) found that 6 months dual therapy was non-inferior to 12 months or longer in terms of composite risk of all cause death myocardial infarction, or stroke (absolute risk difference +0.5%, upper limit of 95% CI = 1.8% [pre-defined non-inferiority margin was 2.0%]).


Pharmacodynamic Effects of Switching From Ticagrelor to Clopidogrel in Patients With Coronary Artery Disease: Results of the SWAP (Switching Antiplatelet Therapy)-4 Study


Pharmacodynamic study (n=80) reported that de-escalation from ticagrelor to clopidogrel therapy is associated with an increase in platelet reactivity suggestive of a drug–drug interaction. A 600mg loading dose of clopidogrel is proposed except in patients who are bleeding.



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: