Postthrombotic Syndrome in Patients Treated With Rivaroxaban or Warfarin for Venous Thromboembolism

Abstract

Postthrombotic syndrome (PTS) is a frequent complication of venous thromboembolism (VTE). Using MarketScan claims data from January 2012 to June 2015, we identified adults with a primary diagnosis code for VTE during a hospitalization/emergency department visit, ≥6 months of insurance coverage prior to the index event and newly started on rivaroxaban or warfarin within 30 days of the index VTE. Patients with <4-month follow-up postindex event or a claim for any anticoagulant during 6-month baseline period were excluded. Differences in baseline characteristics between rivaroxaban and warfarin users were adjusted for using inverse probability of treatment weights based on propensity scores. Patients were followed for the development of PTS starting 3 months after the index VTE. Cox regression was performed and reported as hazard ratios with 95% confidence intervals (CIs). In total, 10 463 rivaroxaban and 26 494 warfarin users were followed for a mean of 16 ± 9 (range, 4-39) months. Duration of anticoagulation was similar between cohorts (median = 6 months). Rivaroxaban was associated with a 23% (95% CI: 16-30) reduced hazard of PTS versus warfarin. Rivaroxaban was associated with a significant risk reduction in symptoms of PTS compared to warfarin in patients with VTE treated in routine practice.

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

“…Another possibility is that there might be a difference in PTS prevalence earlier on, but that this difference evens out after many years since the index VTE event. We assessed our patients for PTS almost 9 years after the index event, which is a much longer interval than in the rivaroxaban studies that mostly assessed PTS after 2 to 3 years 17–21,23,25 …”

“…We assessed our patients for PTS almost 9 years after the index event, which is a much longer interval than in the rivaroxaban studies that mostly assessed PTS after 2 to 3 years. [17][18][19][20][21]23,25 Our study has several limitations. The most important is the cross-sectional design and that the long-term outcomes we assessed were not endpoints of the original RE-COVER studies.…”

“…16 Several studies have suggested that the direct factor Xa inhibitor rivaroxaban compared to warfarin reduces the risk of PTS after DVT. [17][18][19][20][21][22][23][24][25][26] To our knowledge, no studies thus far have compared the effect of warfarin to that of the other DOACs, including apixaban, dabigatran, or edoxaban, on PTS occurrence. Hence, our aim was to compare the long-term prevalence of PTS, recurrent VTE, and health-related quality of life (HRQoL) after acute DVT and pulmonary embolism (PE) among patients randomized to treatment with dabigatran or warfarin in the subpopulations of the RE-COVER studies that were recruited in Canada, Norway, and Sweden.…”

Ривароксабан Снижает Риск Развития Посттромботического Синдрома: Систематический Обзор И Метаанализ

“…Схожие результаты были получены в результате изучения датского национального регистра, который включал значительное количество пациентов с ТГВ, принимавших ПОАК или АВК [17]. Напротив, небольшие исследования более убедительно подтвердили взаимосвязь между приемом ривароксабана и уменьшением риска и степени тяжести ПТС [18][19][20][21].…”

“…Так, в 2018 г. Sogaard et al провели анализ базы данных системы здравоохранения Дании, который указал на сокращение частоты встречаемости ПТС на 12% в группе лечения ривароксабаном [17]. Изучив данные Американского регистра, Coleman et al сообщили о снижении риска ПТС на 23% при сравнении отдаленных результатов антикоагулянтной терапии ривароксабаном и варфарином [21]. С другой стороны, необходимо отметить, что указанные исследования включали пациентов с легочной эмболией независимо от наличия сопутствующего ТГВ.…”