Saturday, 15 May 2021 08:27

Anticoagulation news items. Weeks commencing 10th May 2021

Sex‐influence on the time in therapeutic range (TTR) during oral anticoagulation with coumarin derivatives: systematic review and meta‐analysis

British Journal of Clinical Pharmacology
Review of 22 studies (n=110 to 104,505 of which 183,612 women [45%]) found an association between female sex and worse oral anticoagulation control (OR for TTR=0.87; 95% CI=0.78-0.96; p=0.006, based on meta-analysis of 15 studies).

 

Anticoagulant Use for Atrial Fibrillation Among Persons With Advanced Dementia at the End of Life

JAMA Internal Medicine
Study of 15,217 nursing home residents with AF and advanced dementia in US found ~30% remained on anticoagulation (AC) in last 6 months of life, underscoring fact that whilst there is well-defined threshold for starting AC for AF, there is no clear standard for stopping it.

 

Tranexamic acid and bleeding in patients treated with non-vitamin K oral anticoagulants undergoing dental extraction: The EXTRACT-NOAC randomized clinical trial

PLOS Medicine
RCT (n=218) found use of 10% tranexamic acid mouthwash does not seem to reduce rate of periprocedural or early postop oral bleeding (OB) up to day 7 vs. placebo (occurred in 26.4% vs 28.6%,respectively), but appears to reduce delayed bleeds & postop OB if multiple teeth extracted.

 

Venous thromboembolism

The Lancet
This Seminar focuses on recent (past 5 years) advances in epidemiology, pathophysiology, diagnosis, treatment, and prevention of deep vein thrombosis of the legs and pulmonary embolism. Future directions are also discussed.

 

Andexanet alfa for reversing anticoagulation from apixaban or rivaroxaban - guidance (TA697)

National Institute for Health and Care Excellence
Andexanet alfa is recommended as an option for reversing anticoagulation from apixaban or rivaroxaban in adults with life-threatening or uncontrolled bleeding, only if requirements met as outlined in guidance.

 

Effectiveness and safety of oral anticoagulants in elderly patients with atrial fibrillation

Heart
Nationwide cohort study of patients ≥75 years (n=30,401) found that when initiating oral anticoagulation for AF, standard and reduced dose DOACs had similar risks of stroke/systemic embolism as warfarin and lower or similar risks of 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:

http://www.evidence.nhs.uk/about-evidence-services/content-and-sources/medicines-information/new-medicines-awareness-services