Safety and efficacy of aspirin, unfractionated heparin, both, or neither during endovascular stroke treatment (MR CLEAN-MED): an open-label, multicentre, randomised controlled trial

The Lancet
RCT (n=663), stopped early due to safety concerns, found risk of symptomatic intracranial haemorrhage was higher in patients randomised to aspirin (14% v 7% in those not on aspirin; adjusted OR 1.95 [95% CI 1.13–3.35]) and unfractionated heparin (13% v 7%; 1.98 [1.14–3.46]).

Comparison of Clopidogrel Monotherapy After 1 to 2 Months of Dual Antiplatelet Therapy With 12 Months of Dual Antiplatelet Therapy in Patients With Acute Coronary Syndrome: The STOPDAPT-2 ACS Randomized Clinical Trial

JAMA Cardiology
RCT (n=4136) found effectiveness of clopidogrel monotherapy after 1 to 2 months of dual antiplatelet therapy (DAPT) is inconclusive (1-year incidence rate of primary end point of CV & bleeding events = 3.2% vs. 2.8% in 12-month DAPT group, failing to meet noninferiority criteria).

Benefits and harms of direct oral anticoagulation and low molecular weight heparin for thromboprophylaxis in patients undergoing non-cardiac surgery: systematic review and network meta-analysis of randomised trials

British Medical Journal
Review (68 RCTs; n=45 445) found DOACs & low/high dose LMWH reduced VTE vs.no active treatment (OR 0.17, 95% CI 0.07-0.41; 0.33, 0.16-0.67; 0.19; 0.07-0.54) but probably increase major bleeding (2-3 fold) to similar extent; DOACs probably prevent symptomatic VTE to greater extent.

Oral anticoagulants in patients with atrial fibrillation at low stroke risk: a multicentre observational study

European Heart Journal
Study (n=59,076) suggests NOACs may be linked to positive net clinical benefit, with lower stroke rate (HR 0.72; 95% CI 0.56–0.94) & no increase intracranial haemorrhage (ICH) risk vs. no treatment & similar stroke rate vs. VKAs but lower rate ICH with NOACs (HR 0.63; 0.42–0.94).

DTB Select: Risk of gastrointestinal bleeding with concomitant NOAC and glucocorticoid treatment

Drug and Therapeutics Bulletin
Summary and context are provided on a case-control study that found concomitant treatment with a NOAC and an oral glucocorticoid was associated with a modest increase in the risk of a bleeding event compared with no glucocorticoid exposure.

Evaluation of antithrombotic use and COVID-19 outcomes in a nationwide atrial fibrillation cohort

Heart
Study found pre-existing antithrombotic use associated with lower odds of Covid-related death (OR 0.92, 95%CI 0.87-0.96) and although this link may not be causal, researchers suggest it provides further incentive to improve antithrombotic coverage for eligible individuals with AF.

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