Items filtered by date: November 2021

Milvexian for the Prevention of Venous Thromboembolism

New England Journal of Medicine
In this Phase II study of patients undergoing knee arthroplasty (n=1242), the oral factor XIa inhibitor milvexian was associated with venous thromboembolism in 7% to 25% depending on the dose used, as compared to 21% taking enoxaparin 40mg once daily.

 

Comparison of the HAS-BLED versus ORBIT Scores in Predicting Major Bleeding Among Asians Receiving the Direct-Acting Oral Anticoagulants

British Journal of Clinical Pharmacology
Thai retrospective study (n=961) found HAS-BLED and ORBIT scores showed a similar moderate predictive performance on bleeding using the C-statistic test, with no significant difference between scores (0.65 vs 0.64, p=0.62).

 

NHS England strikes new agreement to expand use of DOACs for atrial fibrillation

NHS England
NHS England are intending to scale up the use of DOACs with as many as 610,000 more patients expected to benefit over the next three years. A procurement deal on DOACs has been reached to help expand access by making treatment more affordable.

 

 

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

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Tranexamic acid in gastrointestinal bleeding: A systematic review and meta-analysis

Critical Care Medicine
Systematic review (12 RCT's) found extended-use high-dose IV tranexamic acid did not improve mortality or bleeding risk & increases adverse events (DVT, PE & seizures). Low-dose/enteral tranexamic acid reduced risk of rebleeding and need for surgery.

 

Comparison of clinical outcomes using activated partial thromboplastin time versus antifactor-Xa for monitoring therapeutic unfractionated heparin: A systematic review and meta-analysis

Thrombosis Research
This systematic review (n=6677, 10 studies) found pooled data suggests no difference in bleeding or thrombosis rates when comparing activated partial thromboplastin time and antifactor Xa heparin assay for monitoring of therapeutic unfractionated heparin.

 

A Randomized Trial of Intravenous Alteplase before Endovascular Treatment for Stroke

New England Journal of Medicine
RCT (n=539) found endovascular treatment (EVT) was neither superior nor noninferior to IV alteplase followed by EVT with regard to disability outcome at 90 days after stroke (OR 0.84; 95% CI, 0.62-1.15) & incidence of symptomatic intracerebral haemorrhage was similar (5.9 v 5.3%).

 

Vaccine-induced immune thrombotic thrombocytopenia (VITT)

The Lancet Haematology
Viewpoint discusses epidemiology, pathophysiology, and optimal diagnostic and therapeutic management of VITT. Presentation of possible VITT should raise prompt testing for anti-PF4 antibodies and initiation of treatment with IV immunoglobulin and non-heparin anticoagulation.

 

 

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

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Oral Anticoagulant Use in Patients with Morbid Obesity: A Systematic Review and Meta-Analysis

Journal of Thrombosis and Haemastasis
Review of 3 RCTs and 18 observational studies in morbidly obese found those on DOACs had lower rates of recurrent VTE than those on vitamin K antagonists (3.83 vs 6.81 per 100 person years). Rates of stroke and systemic embolism and major bleeding events were similar.

 

Using oral anticoagulants in breastfeeding women

Specialist Pharmacy Service
Evidence summary notes thromboembolic disease management whilst breastfeeding is challenging. Warfarin is the preferred choice, but guidance on using DOACs is also provided. It notes recommendations apply to full-term and healthy infants only.

 

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

Published in News