Heparin use in acute coronary syndromes and cardiovascular interventions: habit or evidence based?

European Heart Journal
Viewpoint argues certain applications of unfractionated heparin remain guided by historical experience rather than robust clinical trials, and that further studies are required to evaluate indication, dosing, and monitoring required for use in routine cardiovascular procedures.

Clotting factor concentrates for preventing bleeding and bleeding‐related complications in previously treated individuals with haemophilia A or B

Cochrane Database of Systematic Reviews
Review (10 RCTs; n=608) concludes prophylaxis may reduce bleeding frequency and improve joint function, pain and quality of life vs on-demand treatment, even though this does not translate into a detectable improvement of articular damage when assessed by MRI.

Antithrombotic therapy for ambulatory patients with multiple myeloma receiving immunomodulatory agents

Cochrane Database of Systematic Reviews
This living systematic review (4 RCTs, n=1042) found that the certainty of the available evidence for the comparative effects of aspirin, vitamin K antagonist, low molecular weight heparain, and DOAC on all‐cause mortality, DVT, PE, or bleeding was either low or very low.

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

Direct Oral Anticoagulants versus Warfarin in Patients with Atrial Fibrillation: Patient-Level Network Meta-Analyses of Randomized Clinical Trials with Interaction Testing by Age and Sex

Circulation
Analysis (n=71,683) found standard-dose DOACs linked to significantly lower risk of stroke/systemic embolism (3.01 v 3.69%; HR 0.81, 95% CI 0.74-0.89), death (7.76 v 8.42%; 0.92, 0.87-0.97) and intracranial bleeding (0.63 v 1.40%; 0.45, 0.37-0.56) vs. warfarin in this population.

Antiplatelet therapy in cardiovascular disease: current status and future directions

British Journal of Clinical Pharmacology
Article reviews evidence for aspirin and P2Y12 inhibitors in different clinical situations, the place of anticoagulation on top of antiplatelet therapy in atherosclerotic diseases, and considers whether personalised approaches may be useful for maximising benefit/risk ratio.

Revised SPC: Pradaxa (dabigatran) 75mg, 110mg and 150 mg hard capsules

electronic Medicines compendium
Dabigatran is now additionally licensed for the treatment of VTE and prevention of recurrent VTE in paediatric patients from birth to less than 18 years of age.

Effect of Anticoagulant Therapy for 6 Weeks vs 3 Months on Recurrence and Bleeding Events in Patients Younger Than 21 Years of Age With Provoked Venous Thromboembolism. The Kids-DOTT Randomized Clinical Trial

Journal of the American Medical Association
In this RCT involving 417 patients it was shown that symptomatic recurrent VT occurred in 0.66% vs 0.7% of 6 week vs 3 month course recipients and clinically relevant bleeding in 0.65% vs 0.7% respectively thereby meeting the defined criteria for clinical non-inferiority.

Anticoagulant Treatment Regimens in Patients with Covid-19: A Meta-Analysis

Clinical Pharmacology and Therapeutics
Review (10 RCTs; n=5753) found similar risk of death & net adverse clinical events (death, thromboembolic events, major bleeding) between higher-dose (HD including therapeutic & intermediate-dose) anticoagulation & prophylactic-dose, thus not supporting routine use of HD regimens.

Pradaxa (dabigatran etexilate): Prescriber guide for paediatric use for the treatment of venous thromboembolic events (VTE) and prevention of recurrent VTE

Boehringer Ingelheim
Guide discusses the paediatric indication, contraindications, dosing, populations at higher bleeding risk, perioperative management, coagulation tests, overdose, management of complications, special guidance for use of the oral solution, and the patient alert card and counselling.

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