NIHR Signal: People leaving hospital after medical illness do not benefit from extended clot reducing treatment

National Institute for Health Research Signal

Commentary is provided of trial which found continued use of rivaroxaban offered very small reduction in VTE risk, but also slightly increased risk of major bleeding (neither statistically significant). Trial was terminated because of lower than expected number of clots.

Efficacy and safety of reduced-dose non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: a meta-analysis of randomized controlled trials

European Heart Journal

Data from phase 3 trials found that, irrespective of direct oral anticoagulant (DOAC) used, rates of stroke or systemic embolism and major bleeding were higher in those eligible for reduced-dose DOACs than in those eligible for full-dose DOACs (2.70% vs 1.60% and 4.35% vs 2.87%).

When is it appropriate to stop non-vitamin K antagonist oral anticoagulants before catheter ablation of atrial fibrillation? A multicentre prospective randomized study

European Heart Journal

Open label RCT (n=326) found a higher intra-procedural heparin requirement with 24-hour skipped DOACs vs single dose skipped and uninterrupted regimens (p<0.001) though the incidence of major bleeding up to 1 month after ablation did not differ.

Association of Parenteral Anticoagulation Therapy With Outcomes in Chinese Patients Undergoing Percutaneous Coronary Intervention for Non–ST-Segment Elevation Acute Coronary Syndrome

JAMA Internal Medicine

Chinese cohort study (n=6,804) found that parenteral anticoagulant therapy did not reduce the incidence of in-hospital death, or rate of myocardial infarction vs those that did not receive it. Bleeding was more frequent with anticoagulation (2.5% vs 1.0%, p<0.001).

Human coagulation factor X for hereditary factor X deficiency (all ages)

NHS England

NHS England will not routinely commission human coagulation factor X for people of all ages with hereditary factor X deficiency who need long term prophylaxis owing to insufficient published evidence.

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