Nebulised heparin for patients with or at risk of acute respiratory distress syndrome: a multicentre, randomised, double-blind, placebo-controlled phase 3 trial

The Lancet Respiratory Medicine
Australian RCT (n=252) found no difference in Short Form 36 Health Survey Physical Function Score at day 60 in patients treated with nebulised heparin or placebo (mean 53.6 vs 48.7; difference 4.9; 95% CI −4.8 to 14.5]; p=0.32).

Thrombosis, Bleeding, and the Observational Effect of Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19

Annals of Internal Medicine
Study (n=3,239) found during median follow-up of 27 days, patients who received early therapeutic anticoagulation had similar risk for death as those who did not (hazard ratio, 1.12 [95% CI, 0.92 to 1.35]) and reports early therapeutic anticoagulation did not affect survival.

National Institute for Health Research Alert: Aspirin could reduce the risk of heart attack or stroke in people with pneumonia, research suggests

National Institute for Health Research
Expert commentary is provided for a cohort study which found the risk of cardiovascular events six months after pneumonia diagnosis was one-third lower among aspirin users. Although this is a promising finding, use of aspirin for pneumonia cannot be recommended at present.

Valvular atrial fibrillation and a CHA2DS2-VASc score of 1—a statement of the ESC working group on cardiovascular pharmacotherapy and ESC council on stroke

European Heart Journal
Consensus statement provides factors to consider when reviewing the risk/benefit decision for anticoagulation in patients with CHA2DS2-VASc score of 1. A decision tree is provided to support clinicians.

Antiplatelet therapy in patients with myocardial infarction without obstructive coronary artery disease

Heart
Patients with MI with non-obstructive coronary arteries, when compared to those with obstructive CAD, had lower overall and CV mortality, repeat MI and major bleeding; intensified clopidogrel offered no additional benefit (2.1% v 0.6% standard dose experienced primary outcome).

Atrial fibrillation

New England Journal of Medicine
This article on atrial fibrillation begins with a case vignette, then goes on to discuss diagnosis and evaluation, treatment (rate control; stroke prevention; maintenance of sinus rhythm), and guidelines, and concludes with the authors clinical recommendations.

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

Apixaban or Vitamin K Antagonists and Aspirin or Placebo According to Kidney Function in Patients with Atrial Fibrillation After Acute Coronary Syndrome or PCI: Insights from The AUGUSTUS Trial

Circulation
Review of the AUGUSTUS trial (n=4,456, reporting apixaban caused less bleeding and fewer hospitalisations than vitamin K antagonists in AF after ACS or PCI) found the safety and efficacy of apixaban was consistent irrespective of kidney function, as compared with warfarin.

Effect of Endovascular Treatment Alone vs Intravenous Alteplase Plus Endovascular Treatment on Functional Independence in Patients With Acute Ischemic Stroke: The DEVT Randomized Clinical Trial

Journal of the American Medical Association
RCT in 234 patients with acute ischaemic stroke found endovascular treatment (EVT) alone was noninferior to i/v alteplase plus EVT (functional independence at 90 days was achieved in 54.3% vs 46.6% respectively, a difference that met the prespecified noninferiority margin of 10%).

Effect of Mechanical Thrombectomy Without vs With Intravenous Thrombolysis on Functional Outcome Among Patients With Acute Ischemic Stroke: The SKIP Randomized Clinical Trial

Journal of the American Medical Association
Trial in patients (n=204) with acute large vessel occlusion stroke failed to demonstrate non-inferiority (NI) of mechanical thrombectomy (MT) alone vs. combined i/v thrombolysis plus MT for favourable functional outcome (OR 1.09 [95% confidence limit below the NI margin of 0.74]).

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

Residual risks of ischaemic stroke and systemic embolism among atrial fibrillation patients with anticoagulation: large-scale real-world data (F-CREATE project)

Heart
In this Japanese retrospective cohort study (n=11,848), there were 0.57 cases of ischaemic stroke and systemic embolism per 100 person-years during mean of 3 yrs; 30% (95% CI 16.1-41.6%) of risk was attributable to modifiable risk factors (hypertension, diabetes, dyslipidaemia).

Positive Phase III results for valoctocogene roxaparvovec in the treatment of severe haemophilia A

Biospace Inc.
In the GENEr8-1 study (n=134), a single dose of valoctocogene roxaparvovec reduced annualised bleeding rate from a mean of 4.8 episodes per year at baseline to 0.8 per year, after a mean follow-up of 71.6 weeks (p<0.0001).

Revised SPC: Lixiana (edoxaban) Film-Coated Tablets – all strengths

electronic Medicines compendium
SPC advises that for patients unable to swallow, tablets may be crushed and mixed with water/apple puree and immediately administered. Alternatively, tablets may be crushed and suspended in water and immediately delivered through a gastric tube followed by flushing with water.

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

COVID-19, immunothrombosis and venous thromboembolism: biological mechanisms

Thorax
Review explores the pathobiological mechanisms of immunothrombosis and VTE in COVID-19 focusing on COVID-19-associated coagulopathy, pathology, endothelial dysfunction and haemostasis, the immune system and thrombosis, genetic associations and additional thrombotic mechanisms.

SSRI/SNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery

Medicines and Healthcare products Regulatory Agency
Data from observational studies suggest use of SSRI/SNRI antidepressants during month before delivery may result in small increased risk of postpartum haemorrhage. Prescribers should consider this risk vs. benefits of antidepressants for patient's mental health during this time.

Compression stockings in addition to low-molecular-weight heparin to prevent venous thromboembolism in surgical inpatients requiring pharmacoprophylaxis: the GAPS non-inferiority RCT

National Institute for Health Research
RCT (n=1,858) found pharmaco-thromboprophylaxis alone was non-inferior to a combination of pharmaco-thromboprophylaxis and graduated compression stockings in terms of venous thromboembolism up to 90 days after surgery (1.7% vs 1.4%, p<0.001 for non-inferiority).

Evolution of antithrombotic therapy in patients undergoing percutaneous coronary intervention: a 40-year journey

European Heart Journal
Article aims to provide an overview of the important milestones in antithrombotic pharmacology that have shaped clinical practice of today while also providing insights into knowledge gaps and future directions.

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