Comparison of the recanalization rate and postthrombotic syndrome in patients with deep venous thrombosis treated with rivaroxaban or warfarin

Soares, Rafael de Athayde; Matielo, Marcelo Fernando; Neto, Francisco Cardoso Brochado; Nogueira, Monica Paschoal; Almeida, Rogério Duque de; Sacilotto, Roberto

doi:10.1016/j.surg.2019.05.030

Cited by 31 publications

(28 citation statements)

References 20 publications

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Section: Introductionmentioning

confidence: 99%

“…The effectiveness and safety of rivaroxaban are higher than for some traditional antithrombotic drugs in clinical practice. 10,11 According to a retrospective cohort study of patients with nonvalvular atrial fibrillation, rivaroxaban reduced the incidence of severe stroke and all-cause mortality after the stroke, relative to warfarin. 12 However, the recommended dose of rivaroxaban was determined for patients aged !18 years, and there are few studies regarding the effectiveness and safety of its use specifically for the elderly patients.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of Effectiveness, Safety, and Bleeding Related to Rivaroxaban in Elderly Patients

Hou

Zhang

et al. 2020

Clin Appl Thromb Hemost

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This study explored the efficacy and safety of rivaroxaban in elderly patients, at different doses and age of patients, and analyzed risk factors of bleeding. A retrospective analysis was conducted of 299 patients aged 60 years or older who were admitted to the First Hospital of Jilin University between January 2016 and August 2018. It was found that the rate of bleeding events (but not embolism) significantly increased as the dose of oral rivaroxaban increased ( P < .001), and with age, especially in patients aged ≥80 years ( P = .001, both). The multivariate logistic regression analysis indicated that age (odds ratio [OR]: 2.963, 95% CI: 1.627-5.396) and the daily dose of rivaroxaban (OR: 2.325, 95% CI: 1.483-3.645) were independent risk factors for bleeding. The study determined that rivaroxaban anticoagulant therapy is effective in the elderly patients, but the risk of bleeding increases with age, and is a concern especially in the most old patients. The recommended daily dose of rivaroxaban is effective, but a lower dose is safer for the elderly patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Analysis of Effectiveness, Safety, and Bleeding Related to Rivaroxaban in Elderly Patients

Hou

Zhang

et al. 2020

Clin Appl Thromb Hemost

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“…Two different registry studies have also suggested a benefit of rivaroxaban compared to warfarin regarding the prevalence of PTS 20,21 . In a prospective, randomized single‐center study from Brazil, 84 patients were assessed for PTS 12 months after DVT and there was a statistically significant lower prevalence of PTS in patients treated with rivaroxaban compared to those treated with warfarin (8.7% versus 28.9%, respectively, P < .01) 22 . Another retrospective multicenter study from Brazil also concluded with a possible benefit of rivaroxaban over warfarin after 15 months among 127 patients with DVT (50.7% vs. 69%, P = .002) 23 .…”

Section: Discussionmentioning

confidence: 99%

Post‐thrombotic syndrome in patients with venous thromboembolism treated with dabigatran or warfarin: A long‐term cross‐sectional follow‐up of RE‐COVER study patients

Wik

Kahn

Eriksson

et al. 2021

Journal of Thrombosis and Haemostasis

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Background Studies suggest that the direct factor Xa inhibitor rivaroxaban compared to warfarin reduces the risk of post‐thrombotic syndrome (PTS) after deep vein thrombosis (DVT), but this has not been evaluated for oral direct thrombin inhibitors. Objectives To compare the long‐term prevalence of PTS, recurrent venous thromboembolism (VTE), and health‐related quality of life (HRQoL) in patients with acute DVT and/or pulmonary embolism (PE), randomized to treatment with dabigatran or warfarin in the phase III RE‐COVER studies. Methods We conducted a cross‐sectional follow‐up study of patients randomized in Canada, Norway, and Sweden. PTS was assessed by the patient‐reported Villalta scale (PRV) and HRQoL by EQ‐5D and VEINES‐QOL/Sym. Results We included 349 patients between December 2015 and November 2018; 166 were treated with dabigatran and 183 with warfarin. DVT (+/− PE) was index event in 255 patients, whereas 94 patients had PE only. Mean time from index event was 8.7 (standard deviation 1.4) years. PTS was diagnosed in 63% of patients with DVT and in 46% of patients with PE only, and did not differ between the treatment groups; the crude odds ratio (OR) for PTS in patients treated with dabigatran compared with warfarin was 1.1 (95% confidence interval [CI] 0.6–1.8) after DVT and 1.2 (95% CI 0.5–2.6) after PE only. The prevalence of recurrent VTE was 21% in both treatment groups. HRQoL scores did not differ between groups. Conclusion In this long‐term cross‐sectional study, the prevalence of PTS, recurrent VTE, and HRQoL were similar in patients treated with dabigatran and warfarin.

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“…Most studies reported on 77 -129 patients, with Prandoni et al reporting on a larger retrospective group of 1345 patients. The RCT by Soares et al is unique in that it randomized patients to DOAC or VKA primarily to evaluate the effect on PTS [76]. This Brazilian trial included 84 patients who were followed for a median of one year.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Prevention of the Postthrombotic Syndrome with Anticoagulation: A Narrative Review

et al. 2021

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The post thrombotic syndrome (PTS) is chronic venous insufficiency secondary to a prior deep vein thrombosis (DVT). It is the most common complication of VTE and, while not fatal, it can lead to chronic, unremitting symptoms as well as societal and economic consequences. The cornerstone of PTS treatment lies in its prevention after DVT. Specific PTS preventative measures include the use of elastic compression stockings (ECS) and pharmacomechanical catheter directed thrombolysis (PCDT). However, the efficacy of these treatments has been questioned by large RCTs. So far, anticoagulation, primarily prescribed to prevent DVT extension and recurrence, appears to be the only unquestionably effective treatment for the prevention of PTS. In this literature review we present pathophysiological, biological, radiological and clinical data supporting the efficacy of anticoagulants to prevent PTS and the possible differential efficacy among available classes of anticoagulants (vitamin K antagonists (VKA), low molecular weight heparins (LMWHs) and direct oral anticoagulants (DOACs)). Data suggest that LMWHs and DOACs are superior to VKAs, but no head-to-head comparison is available between DOACs and LMWHs. Owing to their potentially greater anti-inflammatory properties, LMWHs could be superior to DOACs. This finding may be of interest particularly in patients with extensive DVT at high risk of moderate to severe PTS, but needs to be confirmed by a dedicated RCT.

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Comparison of the recanalization rate and postthrombotic syndrome in patients with deep venous thrombosis treated with rivaroxaban or warfarin

Cited by 31 publications

References 20 publications

Analysis of Effectiveness, Safety, and Bleeding Related to Rivaroxaban in Elderly Patients

Analysis of Effectiveness, Safety, and Bleeding Related to Rivaroxaban in Elderly Patients

Post‐thrombotic syndrome in patients with venous thromboembolism treated with dabigatran or warfarin: A long‐term cross‐sectional follow‐up of RE‐COVER study patients

Prevention of the Postthrombotic Syndrome with Anticoagulation: A Narrative Review

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