Thrombosis of atypical location: how to treat patients in the era of direct oral anticoagulants?

Mimier, Małgorzata; Jańczak, Dawid; McBane, Robert D.; Houghton, Damon E.; Wysokiński, Waldemar E.

doi:10.20452/pamw.4333

Cited by 10 publications

(12 citation statements)

References 19 publications

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“…The registrative clinical trials with DOACs enrolled only patients with venous thromboembolism (VTE) of typical sites 7‐9 . Sporadic data about the efficacy and safety of DOACs in the treatment of acute SVT are reported in the literature, while less is known about their application for the secondary prophylaxis of SVT 10,11 . The aim of this study was to assess the efficacy and safety of long‐term treatment with DOACs compared to VKA in high thrombotic risk patients with chronic SVT.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of long‐term anticoagulant treatment for the secondary prophylaxis of splanchnic venous thrombosis

Serrao

Merli

Lucani

et al. 2020

Eur J Clin Investigation

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Background Splanchnic vein thrombosis (SVT) is an uncommon but potentially life‐threatening disease usually related to different underlying clinical conditions. The risk of SVT recurrences is high over time in patients with an underlying permanent prothrombotic condition. Vitamin K antagonists (VKA) represent the mainstay of treatment for SVT. Data about the efficacy and safety of direct oral anticoagulants (DOACs) are reported in the literature for the treatment of acute SVT, but less is known about their application for the secondary prophylaxis of venous thromboembolism (VTE). The aim of this study was to assess the efficacy and safety of long‐term DOACs therapy in patients at high‐risk of thrombosis, compared to VKA. Methods This is a retrospective single‐centre study including 70 patients with SVT on long‐term anticoagulant treatment with VKA followed‐up at our Units between January 2017 and December 2019. All the patients were at high thrombotic risk defined as the presence of a permanent prothrombotic condition requiring long‐term anticoagulation. During follow‐up, 28 patients were shifted to DOACs and their clinical outcomes were compared to those of the patients who continued VKA therapy. All the arterial and venous thrombotic events of the splanchnic and extra‐splanchnic districts as well as the haemorrhagic adverse events occurring during follow‐up were recorded. Results Of the seventy patients enrolled in the study, 36 patients (51.4%) had a single‐segment involvement thrombosis (28.5% of portal vein, 7.1% of superior mesenteric vein, 4.3% of splenic vein, 11.5% of hepatic veins) and 34 patients (48.6%) had multi‐segment involvement at the time of diagnosis. 42 patients (60%) continued VKA therapy and 28 (40%) were switched to DOACs. Median follow‐up was 6 years (range 2‐8) during VKA and 1.9 years (range 1‐5.2) during DOACs. The incidence of thrombotic events was similar between patients on VKA and those on DOACs. Patients on VKA developed deep vein thrombosis (DVT), and of the patients on DOACs 1 developed NSTEMI and 1 DVT. No major haemorrhagic events occurred. Minor bleedings occurred in 26% of patients on VKA and in none of the DOACs patients (P: 0.09). Conclusions Our results highlight that DOACs could represent an effective and safe alternative to the VKA for secondary prophylaxis in SVT patients at high risk of thrombosis.

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Section: Introductionmentioning

confidence: 99%

Outcomes of long‐term anticoagulant treatment for the secondary prophylaxis of splanchnic venous thrombosis

Serrao

Merli

Lucani

et al. 2020

Eur J Clin Investigation

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“…6 Recent larger studies on DOAC therapy for VTE in atypical locations included CVT, thus assessment of the appropriateness of these anticoagulants for the treatment of CVT is warranted. [10][11][12] The objective of this study was to review all available evidence to assess data on safety and efficacy of DOACs in the treatment of CVT.…”

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confidence: 99%

Direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic review

et al. 2021

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ObjectivesCurrent guidelines do not recommend direct oral anticoagulants (DOACs) to treat cerebral venous thrombosis (CVT) despite their benefits over standard therapy. We performed a systematic review to summarise the published experience of DOAC therapy in CVT.Data sourcesMEDLINE, Embase and COCHRANE databases up to 18 November 2020.Eligibility criteriaAll published articles of patients with CVT treated with DOAC were included. Studies without follow-up information were excluded.Data extraction and synthesisTwo independent reviewers screened articles and extracted data. A risk of bias analysis was performed.Primary and secondary outcome measuresSafety data included mortality, intracranial haemorrhage (ICH) or other adverse events. Efficacy data included recurrent CVT, recanalisation rates and disability by modified Rankin Scales (mRS).Results33 studies met inclusion criteria. One randomised controlled trial, 5 observational cohorts and 27 case series or studies reported 279 patients treated with DOAC for CVT: 41% dabigatran, 47% rivaroxaban, 10% apixaban and 2% edoxaban, in addition to 315 patients treated with standard therapy. The observational cohorts showed a similar risk of death in DOAC and standard therapy arms (RR 2.12, 95% CI 0.29 to 15.59). New ICH was reported in 2 (0.7%) DOAC-treated patients and recurrent CVT occurred in 4 (1.5%). A favourable mRS between 0 and 2 was reported in 94% of DOAC-treated patients, more likely than standard therapy in observational cohorts (RR 1.13, 95% CI 1.02 to 1.25).ConclusionThe evidence for DOAC use in CVT is limited although suggests sufficient safety and efficacy despite variability in timing and dose of treatment. This systematic review highlights that further rigorous trials are needed to validate these findings and to determine optimal treatment regimens.

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“…69 Regarding patients with cancer and AF, most data are from observational studies. 81 Random ized studies of patients with cancer and VTE, in cluding the Hokusai VTE Cancer trial with edox aban and SELECT D (Anticoagulation Thera py in Selected Cancer Patients at Risk of Recur rence of Venous Thromboembolism) trial with rivaroxaban, showed that NOACs use compared with dalteparin was associated with reduction in the recurrence rate of VTE and increased risk of major bleeding, mainly GI bleeding. The highest bleeding risk was observed in patients with esoph ageal, gastroesophageal, and urologic cancer.…”

Section: Scoring Systems To Predict Bleeding In Atrial Fibrillationmentioning

confidence: 99%

Bleeding in anticoagulated patients with atrial fibrillation: practical considerations

Undas

Drabik

Potpara

2020

Polish Archives of Internal Medicine

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Bleeding in anticoagulated patients with AF: practical considerations 47 controlled trials (RCTs), NOACs reduced the risk of stroke or SE by 19% compared with warfarin (relative risk [RR], 0.81; 95% CI, 0.73-0.91), large ly due to a markedly lower rate of hemorrhagic strokes (RR 0.49, 95% CI, 0.38-0.64) and intracra nial bleeding (ICB) (RR, 0.48; 95% CI, 0.39-0.59). 9 However, the use of NOACs (in particular, full dose dabigatran and rivaroxaban) was signifi cantly associated with an increased risk of gas trointestinal (GI) bleeding (RR, 1.25; 95% CI, 1.01-1.55). 7 Of note, the differences between baseline stroke and bleeding risks among differ ent NOAC trials could have affected the report ed bleeding rates (FIguRE 1). Residual incidence of stroke or SE despite NOAC use among pa tients with AF is estimated at 1.5% to 2.5% per year and that of major bleeding at 2% to 4% per year. 9 As compared with warfarin, NOACs slight ly reduced all cause mortality (RR, 0.89; 95% CI, 0.85-0.94), vascular mortality (RR, 0.88; 95% CI, 0.82-0.94), and bleeding related mortality (RR, 0.54; 95% CI, 0.44-0.67). 10 Importantly, in the phase 3 AF trials, NOACs were more effective than warfarin in the prevention of stroke or SE among patients with AF aged 75 years or older.

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Thrombosis of atypical location: how to treat patients in the era of direct oral anticoagulants?

Cited by 10 publications

References 19 publications

Outcomes of long‐term anticoagulant treatment for the secondary prophylaxis of splanchnic venous thrombosis

Outcomes of long‐term anticoagulant treatment for the secondary prophylaxis of splanchnic venous thrombosis

Direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic review

Bleeding in anticoagulated patients with atrial fibrillation: practical considerations

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