Oral direct thrombin inhibitors or oral factor Xa inhibitors for the treatment of deep vein thrombosis

Robertson, Lindsay; Kesteven, Patrick; McCaslin, James

doi:10.1002/14651858.cd010956.pub2

Cited by 64 publications

(48 citation statements)

References 57 publications

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“…Finally, most patients received warfarin; although direct oral anticoagulants are now frequently used, this change should not have affected the rates of the post-thrombotic syndrome, since both types of anticoagulation are similarly effective at preventing recurrent deep-vein thrombosis. 15,37 …”

Section: Discussionmentioning

confidence: 99%

Pharmacomechanical Catheter-Directed Thrombolysis for Deep-Vein Thrombosis

et al. 2017

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BACKGROUND The post-thrombotic syndrome frequently develops in patients with proximal deep-vein thrombosis despite treatment with anticoagulant therapy. Pharmacomechanical catheter-directed thrombolysis (hereafter “pharmacomechanical thrombolysis”) rapidly removes thrombus and is hypothesized to reduce the risk of the post-thrombotic syndrome. METHODS We randomly assigned 692 patients with acute proximal deep-vein thrombosis to receive either anticoagulation alone (control group) or anticoagulation plus pharmacomechanical thrombolysis (catheter-mediated or device-mediated intrathrombus delivery of recombinant tissue plasminogen activator and thrombus aspiration or maceration, with or without stenting). The primary outcome was development of the post-thrombotic syndrome between 6 and 24 months of follow-up. RESULTS Between 6 and 24 months, there was no significant between-group difference in the percentage of patients with the post-thrombotic syndrome (47% in the pharmacomechanical-thrombolysis group and 48% in the control group; risk ratio, 0.96; 95% confidence interval [CI], 0.82 to 1.11; P = 0.56). Pharmacomechanical thrombolysis led to more major bleeding events within 10 days (1.7% vs. 0.3% of patients, P = 0.049), but no significant difference in recurrent venous thromboembolism was seen over the 24-month follow-up period (12% in the pharmacomechanical-thrombolysis group and 8% in the control group, P = 0.09). Moderate-to-severe post-thrombotic syndrome occurred in 18% of patients in the pharmacomechanical-thrombolysis group versus 24% of those in the control group (risk ratio, 0.73; 95% CI, 0.54 to 0.98; P = 0.04). Severity scores for the post-thrombotic syndrome were lower in the pharmacomechanical-thrombolysis group than in the control group at 6, 12, 18, and 24 months of follow-up (P<0.01 for the comparison of the Villalta scores at each time point), but the improvement in quality of life from baseline to 24 months did not differ significantly between the treatment groups. CONCLUSIONS Among patients with acute proximal deep-vein thrombosis, the addition of pharmacomechanical catheter-directed thrombolysis to anticoagulation did not result in a lower risk of the post-thrombotic syndrome but did result in a higher risk of major bleeding. (Funded by the National Heart, Lung, and Blood Institute and others; ATTRACT ClinicalTrials.gov number, NCT00790335.)

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Section: Discussionmentioning

confidence: 99%

Pharmacomechanical Catheter-Directed Thrombolysis for Deep-Vein Thrombosis

et al. 2017

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“…Limited data are available to compare these outcomes and further research is needed [5]. Non-vitamin K antagonist (VKA) oral anticoagulant (NOAC) therapy may provide benefits for patient management in ambulatory care compared with low molecular weight heparin (LMWH) overlapping with, and followed by, a VKA [6]. NOAC therapy involves oral administration, no routine coagulation monitoring requirements, a single-drug approach (with rivaroxaban and apixaban) and fewer follow-up appointments [6].…”

Section: Introductionmentioning

confidence: 99%

Pathways for outpatient management of venous thromboembolism in a UK centre

Condliffe

2016

Thrombosis J

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It has become widely recognised that outpatient treatment may be suitable for many patients with venous thromboembolism. In addition, non-vitamin K antagonist oral anticoagulants that have been approved over the last few years have the potential to be an integral component of the outpatient care pathway, owing to their oral route of administration, lack of requirement for routine anticoagulation monitoring and simple dosing regimens.A robust pathway for outpatient care is also vital; one such pathway has been developed at Sheffield Teaching Hospitals in the UK. This paper describes the pathway and the arguments in its favour as an example of best practice and value offered to patients with venous thromboembolism.The pathway has two branches (one for deep vein thrombosis and one for pulmonary embolism), each with the same five-step process for outpatient treatment. Both begin from the point that the patient presents (in the Emergency Department, Thrombosis Clinic or general practitioner’s office), followed by diagnosis, risk stratification, treatment choice and, finally, follow-up.The advantages of these pathways are that they offer clear, evidence-based guidance for the identification, diagnosis and treatment of patients who can safely be treated in the outpatient setting, and provide a detailed, stepwise process that can be easily adapted to suit the needs of other institutions. The approach is likely to result in both healthcare and economic benefits, including increased patient satisfaction and shorter hospital stays.

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“…One should also take into account the level of such recommendations [2B] indicating the clinical suggestion. The above-mentioned level of recommendations arises out of the fact that the majority of phase 3 studies that were conducted met the criteria of non-inferiority studies [43][44][45]. However, as can be seen on the basis of the presented analysis and the results of the XALIA study, the recommendation of the 2016 ACCP consensus is also confirmed by the results obtained in the routine clinical practice.…”

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confidence: 74%