Characteristics of patients with atrial fibrillation prescribed antiplatelet monotherapy compared with those on anticoagulants: insights from the GARFIELD-AF registry

European Heart Journal

In GARFIELD-AF registry (n=51,270 from 35 countries), ~ half of reasons why anticoagulants are withheld in eligible patients are physicians' decisions, which range from perceived low stroke risk, risk of bleeding, falling, or fear of low compliance to guideline recommendations.

Revised SPCs: Advate (human coagulation factor VIII) injection- Baxject II-all presentations

electronic Medicines compendium

Scientific information on inhibitors have been updated in the SPCs.

Desmopressin use for minimising perioperative blood transfusion

Cochrane Database of Systematic Reviews

Review (65 RCTs; n=3874) found that differences in transfusion and blood loss when people were treated with desmopressin or placebo were small and unlikely to be of clinical importance.

Rituximab for treating inhibitors in people with inherited severe hemophilia

Cochrane Database of Systematic Reviews

No RCTs were identified on the efficacy and safety of rituximab for treating inhibitors in people with hemophilia. The evidence base is limited to case reports and case series.

Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial.

Academic Emergency Medicine

RCT (N=124) reported that within 10 minutes of treatment, bleeding was stopped in 73% of the patients in the tranexamic acid group, compared with 29% in the anterior nasal packing group (difference = 44%, 95% CI, 26% to 57%; p < 0.001).

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

Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism

New England Journal of Medicine

RCT (n=1046) found edoxaban was non-inferior to dalteparin given for 6-12 months in terms of composite of recurrent VTE or major bleeding during 12 months after randomisation (12.8% for edoxaban vs 13.5% for dalteparin (HR 0.97; P=0.006 for noninferiority).

Meta-analysis of safety and efficacy for direct oral anticoagulation treatment of non-valvular atrial fibrillation in relation to renal function

Thrombosis Reasearch

Analysis of five RCTs comparing DOACs to warfarin in atrial fibrillation (n=72,608) found stroke risk was lower with DOACs than warfarin in both mild (RR 0.79; 95% CI 0.68–0.91) and moderate (0.80, 0.69–0.92) renal impairment, with no major differences in normal renal function.

Vitamin K antagonists versus low‐molecular‐weight heparin for the long term treatment of symptomatic venous thromboembolism

Cochrane Database of Systematic Reviews

There were no clear differences between low-molecular weight heparin (LMWH) and vitamin K antagonists (VKA) in preventing symptomatic VTE /death after a DVT episode. There were also no clear differences in bleeding episodes when only high-quality studies were considered.

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

Pharmacomechanical Catheter-Directed Thrombolysis for Deep-Vein Thrombosis

New England Journal of Medicine

RCT (n-692) found that between 6 and 24 months, addition of catheter-directed thrombolysis to anticoagulation did not result in lower risk of post-thrombotic syndrome (47% vs. 48%, respectively) but did result in higher risk of major bleeding. (1.7% vs. 0.3%, p= 0.049).

Individualised versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome (IDEAL DVT): a multicentre, randomised, single-blind, allocation-concealed, non-inferiority trial

The Lancet Haematology

This RCT (n=865) reports post-thrombotic syndrome occurred in 29% of patients receiving individualised duration of therapy and 28% of patients receiving standard duration of therapy (absolute difference was 1.1% (95% CI −5.2 to 7.3), thus meeting the non-inferiority margin.

Should This Patient Receive Aspirin?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center

Annals of Internal Medicine

In this discussion, experts review the 2016 US Aspirin Use for the Primary Prevention of Cardiovascular Disease.

Thrombo-embolic prevention after transcatheter aortic valve implantation (TAVI)

European Heart Journal

Optimal antithrombotic strategy and duration to mitigate thrombotic and bleeding risks associated with TAVI remains unclear. This review provides an overview of recent insights in this field, and highlights antithrombotic trials focusing on optimising outcomes in this setting.

Perioperative management of anticoagulant and antiplatelet therapy

Heart

This narrative review discusses assessment of whether interruption of anticoagulation is required, need for and management of perioperative bridging, management of patients who are receiving direct oral anticoagulants (DOACs) and management of those receiving antiplatelets.

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

Oral anticoagulants for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis, and cost effectiveness analysis

British Medical Journal

Review of 23 RCTs (n=94,656) found that apixaban 5mg and dabigatran 150mg twice daily reduced the risk of stroke or systemic embolism vs warfarin. The difference vs warfarin for rivaroxaban or edoxaban was not statistically significant.

Dabigatran versus Warfarin for Acute Venous Thromboembolism in Elderly or Impaired Renal Function Patients: Pooled Analysis of RE-COVER and RE-COVER II

Thrombosis and Haemostasis

Pooled analysis (n=5,107) suggests that dabigatran has better efficacy than warfarin in renal impairment, probably because of an increase in the concentration of dabigatran. Incidence of major bleeding increased with increasing renal impairment for both dabigatran and warfarin.

FDA grant priority review for avatrombopag for thrombocytopenia in patients with chronic liver disease

Biospace Inc.

The market authorisation application in the US is based on the ADAPT 1 and ADAPT 2 phase 3 trials. Avatrombopag is a second generation orally administered thrombopoetin receptor agonist currently under investigation.

Low dose aspirin as adjuvant treatment for venous leg ulceration: pragmatic, randomised, double blind, placebo controlled trial (Aspirin4VLU)

British Medical Journal

RCT (n=251) does not support use of low dose aspirin (150mg daily) as adjuvant treatment for venous leg ulcers (median number of days to healing of largest ulcer: 77 for aspirin vs 69 for placebo; HR 0.85, 95% CI, 0.64 to 1.13, P=0.25).

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