Real world prescribing practices of apixaban or rivaroxaban lead-in doses for the treatment of venous thromboembolism in hospitalized patients

Williams, Matthew; Ahuja, Tania; Raco, Veronica; Papadopoulos, John; Yuriditsky, Eugene; Arnouk, Serena

doi:10.1007/s11239-022-02641-5

Cited by 5 publications

(13 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 14 This bleeding rate was mostly driven by the significantly high rate of CRNMB bleeding in the reduced lead-in group vs the full-duration lead-in group (8% vs 0%; p =0.009). 14 In our study, the higher rate of bleeding witnessed in the parenteral lead-in group may be affected by their significantly lower hemoglobin level at baseline and a higher rate of active cancer. Nonetheless, only the history of MB and orthopedic surgery were significantly associated with higher odds of MB within 90 days in patients receiving DOACs lead-in compared to the parenteral lead-in.…”

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

“… 14 However, patients in the reduced lead-in group received some lead-in doses of apixaban and rivaroxaban and then transitioned to maintenance doses. 14 …”

Section: Discussionmentioning

confidence: 99%

“…13 In addition, a retrospective cohort study showed a higher rate of rVTE within 90 days in patients receiving a reduced lead-in duration of apixaban and rivaroxaban compared to the full lead-in duration (5% vs 1%; p=0.205). 14 However, patients in the reduced lead-in group received some lead-in doses of apixaban and rivaroxaban and then transitioned to maintenance doses. 14 The higher incidence of rVTE we witnessed with the parenteral lead-in group may be driven by the group's significantly older age, higher LOS, and higher number of comorbidities seen at baseline in the parenteral lead-in group, all of which may indicate that these patients may originally be sicker.…”

Section: Discussionmentioning

confidence: 99%

“…12 Although the parenteral anticoagulation lead-in is generally not recommended preceeding apixaban and rivaroxaban, parenteral anticoagulation is often used to replace apixaban or rivaroxaban lead-in doses for the initial phase treatment of VTE. [12][13][14] It has also been noted that prescribers tend to prolong lead-in parenteral anticoagulation before switching to rivaroxaban. 12 Given that the AMPLIFY and EINSTEIN trials excluded patients who had received multiple doses or longer than 48 hours of parenteral anticoagulation before apixaban and rivaroxaban lead-in dosing, 2,3,5 the efficacy and safety of using initial parenteral anticoagulation dosing over lead-in doses of apixaban or rivaroxaban for acute phase VTE treatment remain unpredicted.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Real-World Evaluation of the Safety and Effectiveness of Apixaban & Rivaroxaban Lead-in Dosing Compared to Parenteral Lead-in Dosing in the Treatment of Venous Thromboembolism: A Multi-Center Retrospective Cohort Study

Korayem¹,

Alshaya²,

Alnajjar³

et al. 2023

IJGM

View full text Add to dashboard Cite

Background Although parenteral anticoagulation lead-in is not recommended with apixaban and rivaroxaban, parenteral anticoagulation is often used to replace apixaban or rivaroxaban lead-in doses for the initial phase treatment of VTE. Thus, our study compares the safety and effectiveness of lead-in parenteral anticoagulation to lead-in apixaban or rivaroxaban in patients who received apixaban or rivaroxaban for VTE treatment. Methods A multi-center retrospective cohort study included adult patients (aged ≥ 18 years) admitted to the hospital with acute VTE and treated with either apixaban or rivaroxaban. Patients were grouped depending on the lead-in anticoagulation received for initial VTE treatment into the “Direct oral anticoagulation (DOAC) lead-in” group if patients received an appropriate lead-in dose of apixaban and rivaroxaban and patients who received parenteral lead-in the “parenteral lead-in” group. Results A total of 389 patients were included; the DOAC lead-in group included 296 patients, whereas 93 patients were in the parenteral lead-in group. VTE recurrence (rVTE) during hospitalization and within 30 days was numerically higher in the parenteral lead-in group compared to the DOAC lead-in group (3.3% vs 0.6%; p =0.09 and 1.1% vs 0.7%; p =0.560), with a significantly higher number of patients with rVTE at 90 days (5.4% vs 1.4%; p =0.039). However, none of the patient’s characteristics were significantly associated with the incidence of rVTE. In addition, the major bleeding rate during hospitalization was significantly higher among the parenteral lead-in group than in the DOAC lead-in group (14.0% vs 3.7%; p <0.001). Conclusion Parenteral anticoagulation lead-in before starting maintenance of apixaban and rivaroxaban showed a significantly higher risk of bleeding and a trend toward higher VTE recurrence than the DOAC lead-in. This study adds to the evidence supporting the utilization of the DOAC lead-in regimen in treating patients with VTE. Still, larger studies with robust designs are needed to confirm these findings.

show abstract

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

“… 14 However, patients in the reduced lead-in group received some lead-in doses of apixaban and rivaroxaban and then transitioned to maintenance doses. 14 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Real-World Evaluation of the Safety and Effectiveness of Apixaban & Rivaroxaban Lead-in Dosing Compared to Parenteral Lead-in Dosing in the Treatment of Venous Thromboembolism: A Multi-Center Retrospective Cohort Study

Korayem¹,

Alshaya²,

Alnajjar³

et al. 2023

IJGM

View full text Add to dashboard Cite

show abstract

Evaluation of Lead‐In Direct Oral Anticoagulant Prescribing Practices in Newly Diagnosed Venous Thromboembolism

Cho,

Yin,

Dalton

2023

The Journal of Clinical Pharma

View full text Add to dashboard Cite

Various lead‐in dosing strategies have been used in clinical practice for venous thromboembolism (VTE), and guidelines do not currently address if the full lead‐in dosing duration is necessary after receiving parenteral anticoagulation. This study aims to identify if full lead‐in dosing duration surrounding parenteral anticoagulation affects thrombotic and bleeding outcomes. A single‐center, retrospective cohort study was conducted of hospitalized patients diagnosed with VTE and treated with apixaban or rivaroxaban. Patients were grouped depending on duration of lead‐in dosing, with the full lead‐in dosing group considered as the appropriate duration of the DOAC. The primary outcome was the recurrence of VTE within the index admission to six months. Secondary outcomes included major bleeding, clinically‐relevant minor bleeding, and mortality. Ninety‐three patients were prescribed full lead‐in dosing, while 99 patients received reduced lead‐in dosing. The primary outcome of recurrent VTE was similar between the reduced lead‐in group compared to the full lead‐in group (3% vs 2%; p = 1.0). Major bleeding within the index admission was significantly higher in the reduced lead‐in group: 11 vs. 2 (p = 0.02). There were no significant differences in other secondary outcomes. Full lead‐in dosing compared to reduced lead‐in dosing duration for VTE had similar rates of thrombotic and mortality events. The higher rate of major bleeding in the reduced‐lead in dosing group likely reflects the prescribing practices in less stable patients. This study provides evidence to support reduced lead‐in dosing duration in high‐risk patients without compromising efficacy outcomes.This article is protected by copyright. All rights reserved

show abstract

Retrospective, multicenter analysis of the safety and effectiveness of direct oral anticoagulants for the treatment of venous thromboembolism in obesity

Sperry,

Loeb,

Smith

et al. 2024

J Thromb Thrombolysis

View full text Add to dashboard Cite

Real world prescribing practices of apixaban or rivaroxaban lead-in doses for the treatment of venous thromboembolism in hospitalized patients

Cited by 5 publications

References 27 publications

Real-World Evaluation of the Safety and Effectiveness of Apixaban & Rivaroxaban Lead-in Dosing Compared to Parenteral Lead-in Dosing in the Treatment of Venous Thromboembolism: A Multi-Center Retrospective Cohort Study

Real-World Evaluation of the Safety and Effectiveness of Apixaban & Rivaroxaban Lead-in Dosing Compared to Parenteral Lead-in Dosing in the Treatment of Venous Thromboembolism: A Multi-Center Retrospective Cohort Study

Evaluation of Lead‐In Direct Oral Anticoagulant Prescribing Practices in Newly Diagnosed Venous Thromboembolism

Retrospective, multicenter analysis of the safety and effectiveness of direct oral anticoagulants for the treatment of venous thromboembolism in obesity

Contact Info

Product

Resources

About