Outcomes in patients treated with ticagrelor or clopidogrel after acute myocardial infarction: experiences from SWEDEHEART registryDrug Safety Alert: Warfarin - reports of calciphylaxis (syndrome of vascular calcification)

Medicines and Healthcare products Regulatory Agency

An EU-wide review of relevant evidence recently concluded that there is a reasonable possibility that on rare occasions warfarin use might lead to calciphylaxis. Healthcare professionals are advised to consider stopping warfarin and starting appropriate treatment if necessary.

Management of bleeding with non–vitamin K antagonist oral anticoagulants in the era of specific reversal agents

Circulation

This review summarises the evidence around the management of non–vitamin K antagonist (NOACs)-related bleeding, including prevention of bleeding, general principles and supportive measures, nonspecific haemostatic agents, and NOAC-specific reversal agents.

Outcomes in patients treated with ticagrelor or clopidogrel after acute myocardial infarction: experiences from SWEDEHEART registry

European Heart Journal

Study (n=45,073) found the risk of the primary outcome (composite of all-cause death, re-admission with myocardial infarction or stroke) with ticagrelor vs. clopidogrel was 11.7 vs. 22.3% (HR 0.85 [95% CI: 0.78–0.93]).

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

Precision Medicine for Ischemic Stroke

JAMA Neurology

In this article, the authors discuss the future of precision medicine in the field of ischaemic stroke, first looking at the current status of genetic approaches, and then exploring the status of phenotype-based delineations.

Volunteers wanted to help determine the future of pharmacovigilance

Medicines and Healthcare products Regulatory Agency

Web-RADR: Recognising Adverse Drug Reactions is running a survey for healthcare providers, patients, and consumers of medicines to help develop the next generation of online side-effect reporting software.

New product: ALPROLIX (eftrenonacog alfa) powder and solvent for solution for injection

electronic Medicines Compendium

Eftrenonacog alfa is licensed for the treatment and prophylaxis of bleeding in patients with haemophilia B (congenital factor IX deficiency).

Direct oral anticoagulants: unique properties and practical approaches to management

Heart

This is a review of the indications and dosing considerations, clinical efficacy and safety, laboratory monitoring and reversibility considerations and peri-procedural management of the direct oral anticoagulants (DOACs), highlighting strategies to ensure safe and effective DOAC.

European Pharmacovigilance Risk Assessment Committee to begin review of factor VIII medicines for haemophilia A

European Medicines Agency

This review has been initiated following a recent study which suggested that inhibitors develop more frequently in patients on factor VIII (F-VIII) medicines made by DNA recombinant technology than in those receiving (F-VIII) derived from blood.

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 Bleeding and Thrombosis in Patients 70 Years Or Older Using Vitamin K Antagonists

JAMA Internal Medicine

Matched cohort study (n=3313) found compared to patients aged 70-79, those aged 80-89 had similar risk of bleeding, whereas those ≥90 had mildly increased risk of bleeding. Patients in their 80s and 90s had markedly higher risk of thrombosis vs. patients in their 70s.

Association Between CYP2C19 Loss-of-Function Allele Status and Efficacy of Clopidogrel for Risk Reduction Among Patients With Minor Stroke or Transient Ischemic Attack

Journal of the American Medical Association

Chinese study (n=2933) found after day 90 follow-up, clopidogrel-aspirin (CA) reduced the rate of new stroke in the non-carriers but not in carriers of loss-of-function alleles vs aspirin alone.

Impact of Renal Function on Outcomes With Edoxaban in the ENGAGE AF-TIMI 48 Trial

Circulation

In this analysis of ENGAGE AF-TIMI 48 study (n=14,071), findings from prespecified renal subgroups defined by a CrCl of 30-50 and >50mL/min were similar to overall trial results in which high dose edoxaban was comparable to warfarin for prevention of stroke/systemic embolism.

Edoxaban for venous thromboembolism in patients with cancer: results from a non-inferiority subgroup analysis of the Hokusai-VTE randomised, double-blind, double-dummy trial

The Lancet Haematology

Analysis (n=771 with cancer) found recurrent venous thromboembolism (VTE) occurred in 4% of patients on edoxoban and 7% on warfarin (HR 0.53, 95% CI 0.28-1.00) concluding that edoxoban is non-inferior to warfarin in the treatment of patients with cancer with VTE.

Deep vein thrombosis and pulmonary embolism

The Lancet

This seminar focuses on the epidemiology, diagnosis, and treatment of deep vein thrombosis of the legs and pulmonary embolism as well as looking at future research in this area.

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

The association between non-vitamin K antagonist oral anticoagulants and gastrointestinal bleeding: a meta-analysis of observational studies

British Journal of Clinical Pharmacology

Meta-analysis of 8 cohort studies suggest a slightly higher risk of gastrointestinal bleeding with dabigatran use compared with warfarin (risk ratio 1.21; 95% CI, 1.05-1.39), but no significant difference was found between rivaroxaban and warfarin.

Major Bleeding and Hemorrhagic Stroke With Direct Oral Anticoagulants in Patients With Renal Failure: Systematic Review and Meta-Analysis of Randomized Trials

Chest

Study (n=94,897) found direct oral anticoagulants (DOACs) had decreased risk for major bleeding vs vitamin K antagonists when estimated creatinine clearance (eCrCL) 50-80mL/min (RR 0.87, 95%CI 0.81-0.93). However, DOACs' bleeding risk differs from each other when eCrCL<50mL/min.

On-Treatment Outcomes in Patients With Worsening Renal Function With Rivaroxaban Compared With Warfarin: Insights From ROCKET AF

Circulation

Analysis (n=12,612) found among those with on-treatment worsening renal function, rivaroxaban (RV) was linked to lower rates of stroke/systemic embolism vs. warfarin, without increase in composite bleeding endpoint. This was not seen in patients with stable renal function on RV.

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF

European Heart Journal

Two-year outcomes from ongoing, global observational study (n=17,162) found death was most frequent adverse outcome. Stroke-related mortality was not most frequent cause of death, suggesting that as well as anticoagulation, a more comprehensive approach to management is needed.

New "Aspirin-Guide" App for clinicians to help personalise decisions about aspirin use developed by Brigham and Women's Hospital researchers

Biospace Inc.

Researchers have developed a new, free mobile app, "Aspirin-Guide" that calculates both the CVD risk score and the bleeding risk score for individual patients, and helps clinicians decide which patients are appropriate candidates for the use of low-dose aspirin (75 - 81mg daily).

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