Friday, 30 July 2021 19:29

Anticoagulation news items. Weeks commencing 19th and 26th July 2021

Predictors, time course, and outcomes of persistence patterns in oral anticoagulation for non-valvular atrial fibrillation: a Dutch Nationwide Cohort Study

European Heart Journal
Study (n=93 048) found at least 25% of pts were non-persistent with oral anticoagulants (OACs) within 4 years, resulting in increased risk of composite of ischaemic stroke (IS) and IS-related death (HR 1.79, 95% CI 1.49–2.15) and IS (1.58; 1.29–1.93) vs persistence with OACs.

 

Frailty and clinical outcomes of direct oral anticoagulants versus warfarin in older adults with atrial fibrillation: A cohort study

Annals of Internal Medicine
In this analysis of Medicare claims data, only apixaban was consistently associated with lower rates of the composite end point of death, ischaemic stroke, and major bleeding than warfarin across all frailty levels (n=218,738; HR, 0.68 [CI, 0.65 to 0.72].

 

Abelacimab for Prevention of Venous Thromboembolism

New England Journal of Medicine
This trial (n=412) found treatment with abelacimab, a monoclonal antibody that binds to factor XI, was linked to a lower rate of VTE occurrence compared to enoxaparin; 13%, 5% and 4% in the 30mg, 75mg and 150mg abelacimab groups vs 22%, respectively (p<0.001).

 

Antithrombotic therapies in aortic and peripheral arterial diseases in 2021: a consensus document from the ESC working group on aorta and peripheral vascular diseases, the ESC working group on thrombosis, and the ESC working group on cardiovascular pharmacotherapy

European Heart Journal
This consensus document provides guidance on antithrombotic therapy according to arterial disease localisations and clinical presentation and highlights that multidisciplinary team discussions are important in patients with uncertain ischaemic/bleeding balance.

 

Standard prophylactic versus intermediate dose enoxaparin in adults with severe COVID-19: A multi-center, open-label, randomized controlled trial

Journal of Thrombosis and Haemastasis
RCT of 176 hospitalized adults with severe COVID-19, found no difference in all-cause mortality at 30 days for standard prophylactic dose and intermediate dose enoxaparin (21% vs 15%; HR, 0.67; 95% CI 0.33–1.37; P = 0.31), or rates of arterial or venous thrombosis.

 

COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis (VITT)- guidance (NG200)

National Institute for Health and Care Excellence
This guideline was produced to support clinicians to diagnose and manage this newly recognised syndrome for which there is limited evidence available to inform clinical management. Identification and management of VITT is evolving quickly as the case definition becomes clearer.

 

Risk assessment models for venous thromboembolism in hospitalised adult patients: a systematic review

BMJ Open
Analysis of 51 studies (24 unique risk assessment models [RAMs]) found estimates for sensitivity and specificity were highly variable; results suggest RAMs have generally weak predictive accuracy for VTE, with insufficient evidence to recommend the use of any particular model.

 

Comparative table of low molecular weight heparins and fondaparinux

Specialist Pharmacy Service
This comparative table of low molecular weight heparins and fondaparinux has been compiled to aid product selection should there be a need to switch product in the event of a shortage.

 

Tinzaparin sodium (10,000 IU/ml) 3,500 units in 0.35ml and 4,500 units in 0.45ml pre-filled syringes - Supply Disruption

Medicines and Healthcare products Regulatory Agency
These pre-filled syringes will be unavailable between middle of October 2021 and January 2022 (date TBC). All other presentations of tinzaparin remain unaffected by this supply disruption. This alert contains further information and action for providers.

 

 

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