Friday, 25 February 2022 21:14

Anticoagulation news items. Weeks commencing 21st February 2022

Anticoagulation for the initial treatment of venous thromboembolism in people with cancer

Cochrane Database of Systematic Reviews
Updated review including 15 RCTs (n=1615) found low molecular weight heparin is probably superior to unfractionated heparin for initial VTE treatment in cancer. Additional trials focusing on patient‐important outcomes will further inform the questions addressed in this review.

 

Prevalence and management of drug interactions between NSAID and antithrombotics in ambulatory care

British Journal of Clinical Pharmacology
This article discusses a prospective intervention study of 782 interactions from an older, polymedicated patient population. It found anticoagulants were involved in 16.1% of the cases and for 61% of all cases, the interacting drugs were prescribed by the same physician.

 

Two-year outcomes of UK patients newly diagnosed with atrial fibrillation: findings from the prospective observational cohort study GARFIELD-AF

British Journal of General Practice
Anticoagulation (AC) treatment vs no AC was linked to significantly lower all-cause mortality & risk of non-haemorrhagic stroke/ systemic embolism (aHR 0.70; 95% CI 0.53 to 0.93 & 0.39; 95% CI 0.24-0.62) and a non-significant higher risk of major bleeding (1.31;95% CI 0.77-2.24).

 

Comparative efficacy and safety of oral anticoagulants for the treatment of venous thromboembolism in the patients with different renal functions: a systematic review, pairwise and network meta-analysis

BMJ Open
Review (10 RCTs; n=37,298) found no significant differences in efficacy of DOACs among the three creatinine clearance subgroups, for acute or extended treatment of VTE. Aapixaban may be associated with lower bleeding risk in CrCl >80 mL/min subgroup; confirmation is needed.

 

Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism

Cochrane Database of Systematic Reviews
Review (34 studies; n=14,931) found combining intermittent pneumatic leg compression (IPC) with pharmacological prophylaxis (PP) reduces incidence of PE & DVT vs. IPC alone (low‐certainty evidence [LCE]). Compared to PP alone, it also reduces incidence of PE(LCE) & DVT (high‐CE).

 

Oral antiplatelet therapy for acute ischaemic stroke

Cochrane Database of Systematic Reviews
Updated review (11 studies, n=42,226) found antiplatelet therapy with aspirin 160-300 mg daily started within 48 hours significantly decreased death & dependency, and reduced risk of early recurrent stroke without a major risk of early haemorrhagic complications.

 

Heparin versus citrate anticoagulation for continuous renal replacement therapy in intensive care: the RRAM observational study

National Institute for Health Research
Analysis of responses to survey from 181 NHS adult general ICUs in England, Wales (n=69,001) found change to regional citrate anticoagulation was not linked to step change in 90-day mortality (OR 0.98, 95% CI 0.89 to 1.08) and is likely to have substantially increased costs.

 

 

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