4- Thursday Pharmacotherapy News – 24th June

1 – Postoperative low molecular weight heparin bridging treatment for patients at high risk of arterial thromboembolism (PERIOP2): double blind randomised controlled trial

• This study aims to determine the efficacy and safety of dalteparin postoperative bridging treatment versus placebo for patients with atrial fibrillation or mechanical heart valves when warfarin is temporarily interrupted for a planned procedure.
• In patients with atrial fibrillation or mechanical heart valves who had warfarin interrupted for a procedure, no significant benefit was found for postoperative dalteparin bridging to prevent major thromboembolism.

Source: The BMJ

2 – Effect of dexamethasone on complications or all cause mortality after major non-cardiac surgery: multicentre, double blind, randomised controlled trial

• This study aims to assess the effect of dexamethasone on complications or all cause mortality after major non-cardiac surgery.
• Participants were randomised to receive either dexamethasone (0.2 mg/kg immediately after the surgical procedure, and on day 1) or placebo.
• Dexamethasone was not found to significantly reduce the incidence of complications and death in patients 14 days after major non-cardiac surgery.

Source: The BMJ

3 – Safety and Efficacy of Single-Dose Ad26.COV2.S Vaccine against Covid-19

• The Ad26.COV2.S vaccine is a recombinant, replication-incompetent human adenovirus type 26 vector encoding full-length severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein in a prefusion-stabilized conformation.
• A single dose of Ad26.COV2.S protected against symptomatic Covid-19 and asymptomatic SARS-CoV-2 infection and was effective against severe–critical disease, including hospitalization and death. Safety appeared to be similar to that in other phase 3 trials of Covid-19 vaccines.

Source: NEJM

4- Pathologic Antibodies to Platelet Factor 4 after ChAdOx1 nCoV-19 Vaccination

• The mainstay of control of the coronavirus disease 2019 (Covid-19) pandemic is vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
• Within a year, several vaccines have been developed and millions of doses delivered.
• Reporting of adverse events is a critical postmarketing activity.
• This study reports findings in 23 patients who presented with thrombosis and thrombocytopenia 6 to 24 days after receiving the first dose of the ChAdOx1 nCoV-19 vaccine (AstraZeneca).
• Vaccination against SARS-CoV-2 remains critical for control of the Covid-19 pandemic.
• A pathogenic PF4-dependent syndrome, unrelated to the use of heparin therapy, can occur after the administration of the ChAdOx1 nCoV-19 vaccine.
• Rapid identification of this rare syndrome is important because of the therapeutic implications.

Source: NEJM

5 – Genetics, pathophysiology, diagnosis, treatment, management, and prevention of migraine

• Migraine is a neurological ailment that is characterized by severe throbbing unilateral headache and associated with nausea, photophobia, phonophobia and vomiting.
• In this review, they describe recent advancements in the genetics, pathophysiology, diagnosis, treatment, management, and prevention of migraine.
• They also discuss the potential roles of genetic and abnormal factors, including some of the metabolic triggering factors that result in migraine attacks.
• This review will help to accumulate current knowledge about migraine and understanding of its pathophysiology, and provides up-to-date prevention strategies.

Source: ScienceDirect

6 – Vaccine Breakthrough Infections with SARS-CoV-2 Variants

• Emerging variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are of clinical concern.
• In a cohort of 417 persons who had received the second dose of BNT162b2 (Pfizer–BioNTech) or mRNA-1273 (Moderna) vaccine at least 2 weeks previously, they identified 2 women with vaccine breakthrough infection.
• Despite evidence of vaccine efficacy in both women, symptoms of coronavirus disease 2019 developed, and they tested positive for SARS-CoV-2
• These observations indicate a potential risk of illness after successful vaccination and subsequent infection with variant virus, and they provide support for continued efforts to prevent and diagnose infection and to characterize variants in vaccinated persons.

Source: NEJM

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