Retrospective Analysis of Direct-Acting Oral Anticoagulants (DOACs) Initiation Timing and Outcomes After Thrombolysis in High- and Intermediate-Risk Pulmonary Embolism

Wolfe, Adam; Phillips, Angela; Tierney, David M.; Melamed, Roman; Qadri, Ghazi; Lillyblad, Matthew P.; Smith, Claire; Hill, Catherine St.; Stenzel, Ashley E.; Beddow, David; Kirven, Justin; Kethireddy, Rajesh; Patel, Love

doi:10.1177/10760296231156414

Cited by 3 publications

(2 citation statements)

References 17 publications

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“…In a recent retrospective study in 102 patients treated with thrombolysis (both systemic and catheter directed), no differences were observed in the 30-day mortality between patients treated with DOACs (early <48 hours or delayed >48 hours) or LMWH after unfractionated heparin, with a reduction in hospitalization in the DOAC group. 58…”

Section: Timing Of Initiation Of Doacs After Thrombolysismentioning

confidence: 99%

“…57 In a recent retrospective study in 102 patients treated with thrombolysis (both systemic and catheter directed), no differences were observed in the 30-day mortality between patients treated with DOACs (early <48 hours or delayed >48 hours) or LMWH after unfractionated heparin, with a reduction in hospitalization in the DOAC group. 58 In a retrospective study, normotensive PE patients treated with catheter-directed thrombolysis were switched to oral anticoagulation early after the procedure; the oral agent was warfarin in 36 patients and DOACs in 26 patients. 59 There was no difference in the time to initiation of oral anticoagulant in the warfarin versus DOAC groups (2.9 vs. 2.3 days; p ¼ 0.16).…”

Section: Timing Of Initiation Of Doacs After Thrombolysismentioning

confidence: 99%

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Direct Oral Anticoagulants for Pulmonary Embolism

Pizzi,

Cimini,

Ageno

et al. 2024

Hamostaseologie

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Venous thromboembolism (VTE) is the third most common cardiovascular disease. For most patients, the standard of treatment has long consisted on low-molecular-weight heparin followed by vitamin K antagonists, but a number of clinical trials and, subsequently, post-marketing studies have shown that direct oral anticoagulants (DOACs) with or without lead-in heparin therapy are effective alternatives with fewer adverse effects. This evidence has led to important changes in the guidelines on the treatment of VTE, including pulmonary embolism (PE), with the DOACs being now recommended as the first therapeutic choice. Additional research has contributed to identifying low-risk PE patients who can benefit from outpatient management or from early discharge from the emergency department with DOAC treatment. There is evidence to support the use of DOACs in intermediate-risk PE patients as well as in high-risk patients receiving thrombolytic treatment. The use of DOACs has also been proven to be safe and effective in special populations of PE patients, such as patients with renal impairment, liver impairment, and cancer.

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Section: Timing Of Initiation Of Doacs After Thrombolysismentioning

confidence: 99%

Section: Timing Of Initiation Of Doacs After Thrombolysismentioning

confidence: 99%

Direct Oral Anticoagulants for Pulmonary Embolism

Pizzi,

Cimini,

Ageno

et al. 2024

Hamostaseologie

View full text Add to dashboard Cite

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Safety and Outcomes with Direct Oral Anticoagulants Versus Vitamin-K Antagonists in Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review, Meta-Analysis, and Meta-Regression

Jain,

Odat,

Ahmed

et al. 2024

Cardiology in Review

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Chronic thromboembolic pulmonary hypertension (CTEPH) is a subtype of pulmonary hypertension characterized by organized thrombi inside the pulmonary vasculature, leading to an increase in pulmonary artery pressure. CTEPH is seen in about 3–4% of patients with acute pulmonary embolism and is associated with poor outcomes. Apart from surgical intervention, lifelong anticoagulation is the mainstay of CTEPH management. Traditionally, CTEPH is managed with vitamin-K antagonists (VKA); however, direct oral anticoagulants (DOACs) are recently gaining popularity. However, the current literature comparing DOACs versus VKAs in CTEPH has inconsistent results. An electronic search of the major bibliographic databases was performed to retrieve studies comparing DOACs versus VKAs in CTEPH patients. For dichotomous outcomes, the odds ratio (ORs) with 95% confidence intervals (CI) were pooled using the DerSimonian and Laird random-effects model to generate forest plots. Statistical significance was considered at P < 0.05. Ten studies were included with 3936 patients (1269 in the DOAC group and 2667 in the VKA group). Treatment with DOAC was associated with no statistically significant difference in the risk of all-cause mortality (OR, 0.78; 95% CI, 0.35–1.71; P < 0.53), venous thromboembolism (OR, 1.19; 95% CI, 0.59–2.40; P = 0.63), major bleeding (OR, 0.68; 95% CI, 0.38–1.22; P = 0.20), and clinically relevant nonmajor bleeding (OR, 1.22; 95% CI, 0.80–1.86; P = 0.37). Our analysis demonstrates that DOACs are noninferior to VKAs in terms of their safety and outcomes profile in CTEPH. Further trials are needed to evaluate more robust evidence and to compare additional outcomes.

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Specific Reversal Agents for Direct Oral Anticoagulants in Acute Stroke

Frol,

Pretnar Oblak,

Šabovič

et al. 2024

Clin Appl Thromb Hemost

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Direct oral anticoagulants (DOACs) changed stroke prevention and decreased the risk of ischemic and hemorrhagic complications in patients on oral anticoagulation (OAC) therapy. The numbers of patients prescribed DOACs has increased rapidly. Availability of specific reversal agents opened new avenues in the prevention and management of DOAC complications. An ideal specific reversal agent for a DOAC in acute stroke is an agent which lacks safety concerns and immediately reverses DOAC anticoagulation activity, thereby enabling effective treatment. Reversal of anticoagulant activity is mandatory in patients with acute ischemic stroke (AIS) before performing therapeutic procedures such as intravenous thrombolysis (IVT) and neurosurgery in intracranial hemorrhage (ICH) in order to improve clinical outcomes. In this manuscript we pursue an interdisciplinary approach in discussing advantages and concerns of specific reversal agents in acute stroke DOAC-treated patients in everyday clinical practice.

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Retrospective Analysis of Direct-Acting Oral Anticoagulants (DOACs) Initiation Timing and Outcomes After Thrombolysis in High- and Intermediate-Risk Pulmonary Embolism

Cited by 3 publications

References 17 publications

Direct Oral Anticoagulants for Pulmonary Embolism

Direct Oral Anticoagulants for Pulmonary Embolism

Safety and Outcomes with Direct Oral Anticoagulants Versus Vitamin-K Antagonists in Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review, Meta-Analysis, and Meta-Regression

Specific Reversal Agents for Direct Oral Anticoagulants in Acute Stroke

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