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Friday, 23 April 2021 16:53

Anticoagulation news items. Week commencing 12th and 19th April 2021

Announcement regarding AstraZeneca vaccine and next steps

NHS England
This letter which follows the updated guidance from the MHRA and the independent Joint Committee on Vaccination and Immunisation, sets out the criteria for administration of the Astra Zeneca vaccine following reports of concurrent thrombosis and thrombocytopenia.

 

Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination

New England Journal of Medicine
Article reports 5 Norwegian cases (age 32 to 54 years) of severe venous thrombosis and thrombocytopenia 7 to 10 days after first vaccine dose, all whom had high level of antibodies to platelet factor 4–polyanion complexes, but no previous exposure to heparin.

 

Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination

New England Journal of Medicine
Report describes 11 German/Austrian pts (9 women; median age 36 years) who developed immune thrombotic thrombocytopenia mediated by platelet-activating antibodies against PF4, which clinically mimics autoimmune heparin-induced thrombocytopenia, 5 to 16 days after vaccination.

 

Screening and management of atrial fibrillation in primary care

British Medical Journal
This review explores the epidemiology, screening, and risk assessment of AF, as well as management of its symptoms (rate and various rhythm control options) and stroke risk (anticoagulation and other treatments), and offers a model for integration of components of AF care.

 

Biomarker-based risk prediction with the ABC-AF scores in patients with atrial fibrillation not receiving oral anticoagulation

Circulation
Data from 2 trials(n=4305) found the ABC-AF scores showed better discrimination vs traditional risk scores & were recalibrated for precise risk estimation in patients not on anticoagulants & could provide improved decision support regarding treatment of individual patient with AF.

 

Guided versus standard antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis

The Lancet
Review (11 RCTs, 3 observational) found guided selection of antiplatelets was associated with a reduction in major adverse cardiovascular events (RR 0.78, 95% CI 0.63–0.95, p=0.015) and other individual outcomes vs standard therapy; outcomes varied according to strategy used.

 

Adverse Events Associated With the Addition of Aspirin to Direct Oral Anticoagulant Therapy Without a Clear Indication

JAMA Internal Medicine
Cohort study (n=3280 at 4 anticoag clinics in Michigan) found ~one-third of patients with AF and/or VTE on a DOAC received aspirin without clear indication, and concurrent use was linked to increased bleeding vs. DOAC monotherapy (6.0 vs. 31.6 bleeds/100 patient years, p= 0.01).

 

microINR for anticoagulation therapy (MIB257)

National Institute for Health and Care Excellence
Evidence summary is provided for this portable device for self-measurement of INR. Reduced blood sample size is an innovative aspect. Evidence comes from 5 observational comparative studies vs laboratory-based and alternative point-of-care meters.

 

 

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