Characteristics of patients receiving extended treatment after incident venous thromboembolism

Albertsen, Ida Ehlers; Jensen, Mogens Krogh; Abdelgawwad, Khaled; Søgaard, Mette; Larsen, Torben Bjerregaard; Nielsen, Peter Brønnum

doi:10.1111/bcpt.13637

Cited by 3 publications

(3 citation statements)

References 29 publications

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“…However, a study from 2021 described that less than 3% of patients with incident VTE received extended treatment after initial standard treatment, suggesting that this recommendation has not been fully implemented in clinical practice. 28 Also, the counterbalanced risks and consequences of anticoagulant-related major bleeding are considerable. A 2021 systematic review and meta-analysis including 27 studies presented a 5-year cumulative incidence of major bleeding with vitamin K antagonists of 6.3% (95% CI 3.6; 10.0) with a case-fatality rate of 8.3% (95% CI 5.1; 12.2).…”

Section: Discussionmentioning

confidence: 99%

Risk of Recurrent Venous Thromboembolism in Selected Subgroups of Men: A Danish Nationwide Cohort Study

Albertsen

Konstantinides

Piazza

et al. 2022

TH Open

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Background Although men are considered at high risk for recurrent venous thromboembolism (VTE), sex-specific data on prognostic factors are lacking. We estimated the cumulative recurrence risks associated with clinical characteristics and comorbidities known or suspected to be associated with the developing of VTE recurrence: major surgery, trauma, history of cancer, rheumatic disorder, ischemic heart disease, congestive heart failure, chronic obstructive pulmonary disease, diabetes, chronic renal disease, varicose veins, alcohol-related diseases, and arterial hypertension. Methods We linked nationwide Danish health registries to identify all incident VTE in- and outpatients in men from 2008 through 2018. Recurrent VTE risk two years after anticoagulant discontinuation was calculated using the Aalen-Johansen estimator, stratified by age above/below 50 years. Results The study included 13,932 men with VTE, of whom 21% (n=2,898) were aged < 50 years. For men aged < 50 years with at least one of the clinical characteristics, two-year recurrence risk ranged from 6% (major surgery) to 16% (history of cancer). For men ≥ 50 years with at least one of the characteristics, recurrence risk ranged from 7% (major surgery) to 12% (ischemic heart disease, chronic obstructive pulmonary disease, and chronic renal disease). Men aged < 50 and ≥ 50 years without the clinical characteristics all had a recurrence risk of 10%. Discussion We demonstrated a two-year recurrence risk of at least 6%, regardless of age category and disease status, in this nationwide cohort of men with VTE. The recurrence risk must be balanced against bleeding risk. However, the high recurrence risk across all subgroups might ultimately lead to greater emphasis on male sex in future guidelines focusing on optimized secondary VTE prevention.

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Section: Discussionmentioning

confidence: 99%

Risk of Recurrent Venous Thromboembolism in Selected Subgroups of Men: A Danish Nationwide Cohort Study

Albertsen

Konstantinides

Piazza

et al. 2022

TH Open

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“…Only a few studies have investigated the extended treatment regimen in venous thromboembolism [ 43 , 44 ]. In Denmark, less than 5% of the patients initiated an extended treatment with 10 mg rivaroxaban or 2.5 mg apixaban which was administered twice daily after an initial treatment period of at least 3 months between 2017 and 2018 [ 45 ]. Using US claims data, DeRemer et al investigated the extended treatment with 2.5 mg vs. 5 mg apixaban among more than 6000 patients with venous thromboembolism who had completed 6 months of an initial treatment [ 46 ].…”

Section: Anticoagulation For Acute and Extended Treatmentmentioning

confidence: 99%

Long-Term Management of Pulmonary Embolism: A Review of Consequences, Treatment, and Rehabilitation

Højen

Nielsen

Overvad

et al. 2022

JCM

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The concept of pulmonary embolism is evolving. Recent and emerging evidence on the treatment of specific patient populations, its secondary prevention, long-term complications, and the unmet need for rehabilitation has the potential to change clinical practice for the benefit of the patients. This review discusses the recent evidence from clinical trials, observational studies, and guidelines focusing on anticoagulation treatment, rehabilitation, emotional stress, quality of life, and the associated outcomes for patients with pulmonary embolism. Guidelines suggest that the type and duration of treatment with anticoagulation should be based on prevalent risk factors. Recent studies demonstrate that an anticoagulant treatment that is longer than two years may be effective and safe for some patients. The evidence for extended treatment in cancer patients is limited. Careful consideration is particularly necessary for pulmonary embolisms in pregnancy, cancer, and at the end of life. The rehabilitation and prevention of unnecessary deconditioning, emotional distress, and a reduced quality of life is an important, but currently they are unmet priorities for many patients with a pulmonary embolism. Future research could demonstrate optimal anticoagulant therapy durations, follow-ups, and rehabilitation, and effective patient-centered decision making at the end of life. A patient preferences and shared decision making should be incorporated in their routine care when weighing the benefits and risks with primary treatment and secondary prevention.

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“…Reduced rivaroxaban dose (RRD) has gained increasing attention as a potential alternative anticoagulation strategy for patients undergoing LAAC [ 11 ]. RRD, which involves a lower dose of rivaroxaban than typically used for anticoagulation, has shown promise as a potential alternative for reduction of DRT and thrombosis events (TE) without increasing bleeding risks [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Effectiveness and Safety Comparison between Reduced Rivaroxaban Dose and Dual Antiplatelet Therapy for Nonvalvular Atrial Fibrillation Patients Following Percutaneous Left Atrial Appendage Closure: A Prospective Observational Study

Li,

Jin,

Yao

et al. 2023

Rev. Cardiovasc. Med.

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Background: Device-related thrombosis (DRT) after successful closure implantation on left atrial appendage (LAA) was considered as a major challenge and optimal strategy on antithrombotic therapy remains to be solved. This study was performed to compare the clinical effectiveness and safety of reduced rivaroxaban dose (RRD) and dual antiplatelet therapy (DAPT) after left atrial appendage closure (LAAC) implantation with the Watchman device. Methods: After successful LAAC, consecutive participants were medicated with a standard DAPT or RRD. The primary endpoints included DRT, thrombosis events (TE), and bleeding events that were documented during a 12-month follow-up period. Results: 767 patients (DAPT: n = 140; RRD: n = 627) were initially included. After propensity score matching (PSM), 140 patients treated with DAPT and 280 patients with RRD were included in each group with similar baseline information, thromboembolic and bleeding risk factors, cardiovascular risk factors and concomitant medication. In the RRD group, 193 patients were on rivaroxaban 15 mg ( ) and 47 received rivaroxaban 10 mg ( ). The incidence of DRT was documented in 12 (9.3%) patients in the DAPT group and 3 (6.3%) in and 7 (3.0%) in (log-rank p = 0.050). DAPT subgroups were more likely to experience shorter time to DRT as compared to ( vs . DAPT hazard ratio (HR) = 0.334, p = 0.015, 95% CI: 0.131–0.850). The median length of DRT in the group was significantly lower than that of the DAPT group (1.721 [1.610–1.818] mm vs . 1.820 [1.725–1.925] mm, p = 0.029). Compared with the unadjusted estimated rates of ischemic events for patients with similar congestive heart failure, hypertension, age 75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65–74 years, sex category ( - ) scores, a significant decrease of 68.6% in ischemic stroke rates was noted in the group, which contributed to a 54.9% reduction of overall thromboembolic events. The overall minor bleeding was not significantly different amongst the three groups ( p = 0.944). Procedural bleeding was more common in the DAPT group, as compared with the and groups. Conclusions: After successful closure implantation, long-term RRD significantly reduced the DRT and TE occurrence compared with DAPT.

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Characteristics of patients receiving extended treatment after incident venous thromboembolism

Cited by 3 publications

References 29 publications

Risk of Recurrent Venous Thromboembolism in Selected Subgroups of Men: A Danish Nationwide Cohort Study

Risk of Recurrent Venous Thromboembolism in Selected Subgroups of Men: A Danish Nationwide Cohort Study

Long-Term Management of Pulmonary Embolism: A Review of Consequences, Treatment, and Rehabilitation

Clinical Effectiveness and Safety Comparison between Reduced Rivaroxaban Dose and Dual Antiplatelet Therapy for Nonvalvular Atrial Fibrillation Patients Following Percutaneous Left Atrial Appendage Closure: A Prospective Observational Study

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