Antiplatelet and direct oral anticoagulation management after coronary artery bypass graft surgery: the Cinderella of current cardiovascular trials, please show me (some) evidence

European Heart Journal
This commentary discusses dual pathway inhibition therapy (DPI; aspirin + low dose direct oral anticoagulant) post coronary artery bypass graft surgery. The authors summarise available data, noting limited data in this specific patient cohort and call for further research.

Pharmacological interventions for preventing clotting of extracorporeal circuits during continuous renal replacement therapy

Cochrane Database of Systematic Reviews
This review of 34 studies (n=1960) found the available evidence does not support the superiority of any anticoagulant to another. Further studies are needed to identify patient populations in which CRRT should commence with no pharmacological anticoagulation or with citrate.

Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis

Thorax
This meta-analysis of 102 studies (n=64503) found patients admitted to the ICU for severe COVID-19 had a high risk of VTE. Further studies are needed to determine the specific effects of COVID-19 on the risk of thrombosis in less severe forms of the disease.

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

Revised SPC: Plavix (clopidogrel) 300 mg film-coated tablets

electronic Medicines compendium
SPC have been updated with licence extension for use in combination with aspirin in adult patients with moderate to high-risk transient ischaemic attack (ABCD2-[1] score ≥4) or minor ischaemic stroke (NIHSS-[2] ≤3) within 24 hours of an event.

Comparative effectiveness of oral anticoagulants in everyday practice

Heart
Registry study (n=25,551) found DOACs were associated with a lower risk of all-cause mortality vs VKAs (3.6 vs 4.8 per 100 patient years, HR 0.79, 95%CI 0.70-0.89) and major bleeding (1.0 vs 1.4, 0.77, 0.61-0.98) with similar risk of non-haemorrhagic stroke or systemic embolism.

Comparison of the Efficacy and Safety Outcomes of Edoxaban in 8040 Women Versus 13 065 Men With Atrial Fibrillation in the ENGAGE AF-TIMI 48 Trial

Circulation
Review of this study found that although pretreatment endogenous factor Xa activity was significantly higher in women than in men, treatment with edoxaban resulted in eventual similar endogenous factor Xa activity, and the efficacy profile was similar between sexes.

Prediction models for recurrence and bleeding in patients with venous thromboembolism: A systematic review and critical appraisal

Thombosis Research
Review (18 studies) findings do not support use of prediction models to weigh risks for recurrence and bleeding when deciding to anticoagulated patients after initial treatment of VTE. Important methodological limitations and insufficient predictive accuracy were found.

Direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic review

BMJ Open
Review of 33 studies (1 RCT, 5 observational cohorts and 27 case series, total n=594) concludes that the evidence for DOACs in cerebral venous thrombosis is limited, but suggests sufficient safety and efficacy vs standard therapy. Further rigorous trials are needed.

Prophylactic anticoagulation for patients in hospital with covid-19

British Medical Journal
This editorial discusses research to date on thromboprophylaxis in patients admitted to hospital with Covid-19 including the interim results from three separate RCTs (anticoagulation arm of REMAP-CAP, ATTACC, and ACTIV4a), widely available before peer-review.

Primary prophylaxis for venous thromboembolism in ambulatory cancer patients receiving chemotherapy

Cochrane Database of Systematic Reviews
This updated review (32 RCTs [6 new]; n=15,678) found LMWH reduce, and direct factor Xa inhibitors may reduce, incidence of symptomatic VTE; both likely increase risk of major bleeding. Evidence for use of thromboprophylaxis with other anticoagulants is limited.

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

Revised SPC: Xarelto (rivaroxaban) film-coated tablets – all strengths

electronic Medicines compendium
SPC updated with license extension for the treatment of venous thromboembolism (VTE) and prevention of VTE recurrence in children and adolescents aged less than 18 years and weighing from 30 kg to 50 kg after at least 5 days of initial parenteral anticoagulation treatment.

Early initiation of prophylactic anticoagulation for prevention of coronavirus disease 2019 mortality in patients admitted to hospital in the United States: cohort study

British Medical Journal
Study of patients admitted to hospital with Covid-19 (n=4297) found receipt of thromboprophylaxis within 24 hours of admission was associated with lower 30-day mortality (14.3% v 18.7% no anticoagulation; HR 0.73, 95% CI 0.66 to 0.81) with no increased risk of severe 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

DOAC Dipstick for detecting direct oral anticoagulants - Medtech innovation briefing [MIB248]

National Institute for Health and Care Excellence
This briefing describes the DOASENSE DOAC Dipstick, which is used for detecting direct oral anticoagulants (DOACs) in urine. A summary of the main relevant evidence is presented along with uncertainties in the evidence, the technology's potential place in therapy and its cost.

Rivaroxaban approved for use in EU (and UK) for treatment, and prevention of recurrence of venous thromboembolism

PharmaTimes
It will be licensed for treatment and prevention of venous thromboembolism recurrence in children from birth to below 18 years old, at least five days after initial parenteral anticoagulation treatment.

Management of Antithrombotic Therapy after Acute Coronary Syndromes

New England Journal of Medicine
This review article notes antithrombotic therapy is a central component of treatment after acute coronary syndromes; however, balancing the benefit with the bleeding risk is still controversial. Clinical research and recommended approaches to management are reviewed.

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