Predictors of use of direct oral anticoagulants in acute pulmonary embolism

Abstract

Introduction:In the past decade, direct oral anticoagulants (DOACs) have been incorporated as an anticoagulation tool in patients with acute pulmonary thromboembolism (PTE). Although they have a better pharmacological profile than Vitamin K antagonists (VKAs), the use of these drugs is not massive. The objective of this study was to evaluate the use of DOACs in patients with acute PE and to detect determinants of its use. Methodology: An analysis of the CONAREC XX registry was performed to detect predictors of DOAC prescription at discharge in patients hospitalized with acute PE in 64 centers in Argentina. Results: A total of 579 patients who received anticoagulation at hospital discharge were analyzed: 60% received VKA, 21% heparin, and 19% DOAC (of them, 49% rivaroxaban, 34% apixaban, and 17% dabigatran). Patients receiving DOACs had less severe PE, lower risk of bleeding, and fewer in-hospital complications. At 30-day follow-up, there were no differences in all-cause mortality or bleeding. Health coverage by social insurance (OR = 7.45, p < 0.01) or by private coverage (OR = 10.5, CI = 95% 2.4-45.9, p < 0.01) was independent predictors of DOAC prescription at discharge, and history of heart failure (OR = 0.19, 95% CI = 0.04-0.84, p = 0.028) and oncological disease (OR = 0.49, 95% CI = 0.27-0.89; p = 0.02) were predictors not prescribe them. Conclusion: One in five survivors of acute PE received DOACs at hospital discharge in Argentina, and this was determined by clinical and economic variables.

Revisão integrativa sobre o uso de anticoagulantes orais diretos em casos de embolia pulmonar aguda

“…Em sua maioria, são prescritos por, pelo menos, três meses após o evento agudo, com o intuito de prevenir a recorrência a longo prazo. A farmacodinâmica desses medicamentos envolve a inibição direta do fator II ou Xa (ambos proteases de serina), impedindo a conversão ativada pela trombina do fibrinogênio em fibrina (BARRIONUEVO B, et al, 2022;LEENTJENS J, et al, 2017).…”