Items filtered by date: July 2022

Association of Antisecretory Drugs with Upper Gastrointestinal Bleeding in Patients Using Oral Anticoagulants: A Systematic Review and Meta-Analysis

American Journal of Medicine
Review (6 observational studies, 1 RCT) found PPIs reduce upper GI bleeding (RR 0.67; 95% CI, 0.61-0.74) with benefit appearing to be most clearcut and substantial in patients with elevated risk of upper GI bleeding (e.g. NSAID or aspirin use, elevated bleeding risk score).

 

Edoxaban switching scheme: worth the risks?

Pharmaceutical Journal
At end of 2021, NHSE&I confirmed details of national scheme to switch thousands of patients to edoxaban. Article notes switching anticoagulants can be particularly complex and there is speculation patients will need to be switched again in future with advent of generic apixaban.

 

 

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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Effectiveness and Safety of Intracranial Events associated with the use of Direct Oral Anticoagulants for Atrial Fibrillation: A Systematic Review and Meta-analysis of 92 Studies

British Journal of Clinical Pharmacology
Analysis of 92 studies with 107 comparisons found significant differences in the risk of ischemic stroke, thromboembolism/stroke, and intracranial haemorrhage associated with individual DOACs compared to other DOACs and Vitamin K antagonists.

 

Phase 1–2 Trial of AAVS3 Gene Therapy in Patients with Hemophilia B

New England Journal of Medicine
Study (n=10) reports sustained factor IX levels in normal range with low doses of FLT180a, a liver-directed adeno-associated virus gene therapy in 9 patients with haemophilia B (median follow 27.2 months) but immunosuppression with glucocorticoids with/without tacrolimus needed.

 

 

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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Intranasal Topical Application of Tranexamic Acid in Atraumatic Anterior Epistaxis: A Double-Blind Randomized Clinical Trial

Annals of Emergency Medicine
RCT (n=240) found addition of tranexamic acid to controlled therapy of phenylephrine & lidocaine was linked to a lower rate of need for anterior nasal packing (50% vs 64.2%; OR 0.56; 95% CI 0.33-0.94), stay in A+E for >2hrs (9.2% vs 20.8%) & rebleeding in 24hrs (15% vs 30%).

 

 

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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Anticoagulants for thrombosis prophylaxis in acutely ill patients admitted to hospital: systematic review and network meta-analysis

British Medical Journal
Review (44 RCTs;n=90 ,095) concluded overall, intermediate dose low-molecular-weight heparin was most likely to reduce symptomatic venous thromboembolism and intermediate dose unfractionated heparin and direct oral anticoagulants most likely to increase risk of major 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

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Rivaroxaban and aspirin vs. aspirin alone in Asian compared with non-Asian patients with chronic coronary artery disease or peripheral arterial disease: the COMPASS trial

European Heart Journal
Analysis found rivaroxaban + aspirin vs aspirin produces similar effects for major adverse cardiovascular events, major bleeding and net clinical outcome but is associated with higher rates of intracranial haemorrhage in Asians.

 

2022 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer, including patients with COVID-19

The Lancet Oncology
Key recommendations include low-molecular-weight heparins for initial (first 10 days) & maintenance treatment of cancer-associated thrombosis or DOACs in patients who are not at high risk of GI or genitourinary bleeding, providing no strong drug interactions or absorption issues.

 

Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT): a pragmatic, multicentre, open-label, registry-linked, randomised, controlled, non-inferiority trial

The Lancet
RCT (n=1600) suggests single bolus of IV tenecteplase (0.25 mg/kg) is a reasonable alternative to alteplase bolus followed by infusion (36·9% vs. 34·8%, respectively, had modified Rankin Scale score of 0–1 at 90–120 days meeting prespecified non-inferiority threshold).

 

Enoxaparin for primary thromboprophylaxis in symptomatic outpatients with COVID-19 (OVID): a randomised, open-label, parallel-group, multicentre, phase 3 trial

The Lancet Haematology
RCT (n=472) found thromboprophylaxis with enoxaparin 40 mg once daily for 14 days does not reduce early hospitalisations & deaths among outpatients with symptomatic COVID-19 versus standard of care (no thromboprophylaxis) and was terminated early due to futility of the treatment.

 

Thromboprophylactic low-molecular-weight heparin versus standard of care in unvaccinated, at-risk outpatients with COVID-19 (ETHIC): an open-label, multicentre, randomised, controlled, phase 3b trial

The Lancet Haematology
Study terminated early due to slow enrolment & lower-than-expected event rate (n=219) found prophylaxis with low-molecular-weight heparin had no benefit for at-risk outpatients with COVID-19 vs. standard-of-care (all cause mortality & hospitalisation at 21 days =11% each group).

 

Prescribing direct-acting oral anticoagulants – mind the evidence gap

British Journal of Clinical Pharmacology
Review notes prescribers may not be aware of the under representation of patient populations commonly encountered in clinical practice within the trials supporting approval of DOACs and highlights the gaps in licensing evidence using 4 clinical vignettes.

 

 

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