Avatrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure – guidance (TA626)

National Institute for Health and Care Excellence
Avatrombopag is recommended as an option for treating severe thrombocytopenia (platelet count of <50,000/microlitre of blood) in adults with chronic liver disease having a planned invasive procedure.

Community pharmacy-based study of adherence to non-vitamin K antagonist oral anticoagulants

Heart
Belgian study (n=766) found a positive patient attitude towards DOAC therapy, with 21% reporting non-adherence according to the Medication Adherence Report Scale, and unintentional non-adherence being the most commonly reported reason (15.4%).

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

Piperacillin/tazobactam-induced coagulopathy in a patient through a vitamin K-dependent mechanism

European Journal of Hospital Pharmacy

Case report describes 70-year-old female patient whose INR increased following piperacillin/tazobactam (PTZ). Coagulopathy was reversed with vitamin K, suggesting PTZ can induce coagulopathy through a vitamin K-dependent mechanism.

DTB Select: DOAC dose adjustment in renal impairment

Drug and Therapeutics Bulletin
Commentary and context are provided for a US registry-based study (n=6,682) which found that of the 4% of people treated with a DOAC who met the criteria for a dose reduction, only 20% of them had an appropriate dose adjustment.

Effect of Ticagrelor Monotherapy vs Ticagrelor With Aspirin on Major Bleeding and Cardiovascular Events in Patients With Acute Coronary Syndrome: The TICO Randomized Clinical Trial

Journal of the American Medical Association
RCT (n=3056) found composite endpoint of major bleeding and CV and cerebrovascular events was less frequent with ticagrelor monotherapy vs dual therapy with aspirin (3.9% vs 5.9%, HR 0.66, p=0.01) but lower than expected event rates should be considered when interpreting results.

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

The Lancet
This RCT in adults with severe GI bleeding (n=12,009) found no difference between tranexamic acid and placebo in death due to bleeding within 5 days (4% v 4%; RR 0.99; 95% CI 0.82-1.18) with a higher risk of VTE events (1.85; 95% CI 1.15-2.98) and seizures (1.73; 1.03-2.93).

The Safety and Efficacy of Aspirin Discontinuation on a Background of a P2Y12 Inhibitor in Patients after Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

Circulation
Meta-analysis of 5 RCTs (n=32,145) found discontinuation of aspirin therapy 1-3 months post PCI reduced major bleeding risk vs continued dual antiplatelet therapy (1.97% vs 3.13%; HR 0.60, 95% CI 0.45-0.79), with no observed increase in MACE (2.73% vs 3.11%; HR 0.88, 0.77-1.02).

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

Risk of Hospitalization With Hemorrhage Among Older Adults Taking Clarithromycin vs Azithromycin and Direct Oral Anticoagulants

JAMA Internal Medicine

Study (n=24,943) found concurrent use of clarithromycin compared with azithromycin was associated with a small, significantly greater 30-day risk of hospital admission with major haemorrhage (adjusted hazard ratio, 1.71 [95% CI, 1.20-2.45]; absolute risk difference, 0.34%).

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

Comparative Efficacy and Safety of Oral P2Y12 Inhibitors in Acute Coronary Syndrome: Network Meta-Analysis of 52,816 Patients from 12 Randomized Trials

Circulation

Ticagrelor reduced CV and all-cause mortality (HR 0.82 and 0.83, respectively) whereas there was no significant mortality reduction with prasugrel vs clopidogrel (0.90 and 0.92, respectively). Both prasugrel and ticagrelor increased major bleeding vs clopidogrel (1.26 and 1.27).

One‐year efficacy and safety of prasugrel and ticagrelor in patients with acute coronary syndromes: Results from a prospective and multicentre ACHILLES registry

British Journal of Clinical Pharmacology
Prospective study (n=1717) found clopidogrel-treated patients had a higher annual rate of cardiovascular mortality, major adverse cardiovascular event and all‐cause mortality (all P< 0.001) without differences in major bleeding (P = 0.587) vs novel oral P2Y12 inhibitors.

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