Direct Oral Anticoagulants or Standard Anticoagulant Therapy in Fragile Patients with Venous Thromboembolism
López Núñez, Juan José (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Pérez Andrés, Ricard (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Di Micco, Pierpaolo (Department of Internal Medicine and Emergency Room, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy)
Schellong, Sebastian (Department of Medical Clinic, Municipal Hospital of Dresden Friedrichstadt, Dresden, Germany)
Gómez-Cuervo, Covadonga (Hospital Universitario 12 de Octubre (Madrid))
Sahuquillo, Joan Carles (Hospital Municipal de Badalona)
Ciammaichella, Maurizio (Department of Emergency Internal Medicine, Ospedale St. John, Rome, Italy)
Morales, Maria del Valle (Hospital del Tajo (Madrid))
Bosevski, Marijan (University Cardiology Clinic, Faculty of Medicine, Skopje, Republic of Macedonia)
Monreal, Manuel (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Universitat Autònoma de Barcelona

Fecha:	2019
Resumen:	Background The efficacy and safety of the direct oral anticoagulants (DOACs) in fragile patients (age ≥ 75 years and/or creatinine clearance levels ≤ 50 mL/min and/or body weight ≤ 50kg) with venous thromboembolism (VTE) has not been evaluated. Methods We used the RIETE database to compare the rates of the composite of VTE recurrences or major bleeding during anticoagulation in fragile patients with VTE, according to the use of DOACs or standard anticoagulant therapy. Results From January 2013 to April 2018, 24,701 patients were recruited. Of these, 10,054 (41%) were fragile. Initially, 473 fragile patients (4. 7%) received DOACs and 8,577 (85%) low-molecular-weight heparin (LMWH). For long-term therapy, 1,298 patients (13%) received DOACs and 5,038 (50%) vitamin K antagonists (VKAs). Overall, 95 patients developed VTE recurrences and 262 had major bleeding. Patients initially receiving DOACs had a lower rate of the composite outcome (hazard ratio [HR]: 0. 32; 95% confidence interval [CI]: 0. 08-0. 88) than those on LMWH. Patients receiving DOACs for long-term therapy had a nonsignificantly lower rate of the composite outcome (HR: 0. 70; 95% CI: 0. 46-1. 03) than those on VKAs. On multivariable analysis, patients initially receiving DOACs had a nonsignificantly lower risk for the composite outcome (HR: 0. 36; 95% CI: 0. 11-1. 15) than those on LMWH, while those receiving DOACs for long-term therapy had a significantly lower risk (HR: 0. 61; 95% CI: 0. 41-0. 92) than those on VKAs. Conclusions Our data suggest that the use of DOACs may be more effective and safe than standard therapy in fragile patients with VTE, a subgroup of patients where the risk for bleeding is particularly high.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Venous thromboembolism ; Fragile patients ; Direct oral anticoagulants
Publicado en:	TH Open: Companion Journal to Thrombosis and Haemostasis, Vol. 3 (march 2019) , p. e67-e76, ISSN 2512-9465

DOI: 10.1055/s-0039-1683970
PMID: 31249985

10 p, 230.8 KB

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Documentos de investigación > Documentos de los grupos de investigación de la UAB > Centros y grupos de investigación (producción científica) > Ciencias de la salud y biociencias > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
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