Venous thromboembolism therapy with rivaroxaban in daily-care patients: Results from the Dresden NOAC registry

Keller, Loretta; Marten, Sandra; Hecker, Judith; Sahin, Kurtuluş; Tittl, Luise; Beyer‐Westendorf, Jan

doi:10.1016/j.ijcard.2017.10.097

Cited by 22 publications

(21 citation statements)

References 24 publications

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“…In the randomized Einstein-DVT Dose-Ranging study (n = 543), nine patients on rivaroxaban 20 mg (out of 135, 7%), 7 on rivaroxaban 30 mg (out of 134, 5%) and 5 on rivaroxaban 40 mg (out of 136, 4%) discontinued prematurely because of adverse events [11]. In the ongoing, prospective, non-interventional Dresden NOAC Registry, 3.6% of patients (out of 411) on rivaroxaban for acute lower limb DVT and/or PE had an unplanned, complete discontinuation (6.1% at 12 months) [13]. Informing patients of possible rivaroxaban adverse effects in the early stage of treatment is a priority for all health professionals.…”

Section: Discussionmentioning

confidence: 99%

“…A retrospective study evaluated the medication possession ratio (MPR) to rivaroxaban and warfarin in DVT [10]. Three studies evaluated discontinuation to rivaroxaban caused by adverse effects [11][12][13]. One study compared three different adherence tools (eCAP™, medication diaries, and pill count) to monitor rivaroxaban (n = 19) and apixaban (n = 20) [14].…”

Section: Introductionmentioning

confidence: 99%

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Patient adherence to rivaroxaban in deep vein thrombosis, a cohort study in Switzerland: quantitative results

et al. 2019

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Background Direct oral anticoagulants (DOACs) have the advantage of being administered orally at a fixed dose without laboratory monitoring, in contrast to the frequent international normalized ratio measurements used to adjust for vitamin K antagonists dosing. Rivaroxaban, has a short half-life. The anticoagulation effect rapidly decreases if medication adherence is suboptimal. Objective The purpose of this quantitative study (called RIVA) is to longitudinally describe adherence to rivaroxaban (implementation and persistence) in patients with deep vein thrombosis (DVT). Setting The community pharmacy of the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland in collaboration with the angiology division of the Lausanne University Hospital (CHUV). Methods This is an observational study. Patients received rivaroxaban for 3 or 6 months: 15 mg twice a day during the first 3 weeks and then 20 mg once a day until the end of the treatment. Adherence was measured using electronic monitoring. Implementation and adherence were modelled using a generalized estimating equation model. Persistence was represented using a Kaplan-Meier survival curve. Main outcome measure Medication adherence (implementation and persistence). Results Thirty-one consecutive patients were included (68% male, mean age: 47 years old). The collected adherence data consisted of 57 inter-visit phases, 2899 electronic monitoring openings and a median follow-up of 92 days (IQR: 87; 100). Implementation to rivaroxaban was initially high [96.3 (92.8; 98.1)] but decreased during the first 3 weeks, until it reached 89.3 (76.0; 95.6). After the switch from twice a day 15 mg to a once a day 20 mg regimen, implementation increased again and remained stable [95.4 (92.2; 97.3)] for 90 days. Four patients who experienced adverse events discontinued the treatment before the end of the study and were considered non-persistent (clinically appropriate discontinuation). Conclusion Adherence to rivaroxaban in deep vein trombosis is high in persistent patients. Discontinuation is related to rivaroxaban adverse effects/toxicity. Implementation should be reinforced during the twice a day-phase, and this first 3-week experience should help patients and healthcare professionals choose the best timing for the once a day phase.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patient adherence to rivaroxaban in deep vein thrombosis, a cohort study in Switzerland: quantitative results

et al. 2019

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“…We utilized the Cochrane Risk of Bias Tool, 11 to evaluate the included RCTs, [3][4][5][6][7][8][9][10][12][13][14][15][16][17][18][19][20][21][22] and the Newcastle-Ottawa scale, 23 to evaluate the observational studies. [24][25][26][27][28][29][30] The quality assessment was performed by two reviewers independently, and any disagreement was resolved via consensus.…”

Section: Assessment Of Risk Biasmentioning

confidence: 99%

“…The bias introduced in the observational studies was mainly attributed to the lack of comparability of the cohorts involved. For six of the studies, [24][25][26][27][28]30 there was no attempt to improve the comparability of the cohorts as the only differentiation used was event outcomes.…”

Section: Assessment Of Risk Of Biasmentioning

confidence: 99%

Comparative Efficacy and Safety of Sulodexide and Other Extended Anticoagulation Treatments for Prevention of Recurrent Venous Thromboembolism: A Bayesian Network Meta-analysis

Pompilio

Integlia

Raffetto

et al. 2020

TH Open

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Objective This network meta-analysis (NMA) assesses the clinical comparative efficacy and safety of sulodexide versus direct-acting oral anticoagulants (DOACs), vitamin K antagonist (VKA), and aspirin in patients with an unprovoked venous thromboembolism (VTE). Methods We conducted a literature search in MEDLINE, Embase, and Cochrane Library using both randomized controlled trials (RCTs) and observational studies. Reduction in recurrent deep venous thrombosis (r-DVT), pulmonary embolism (PE), major bleeding (MB), clinically relevant nonmajor bleeding (CRNMB) were the primary efficacy and safety outcomes. Other secondary end points were also included. We performed a fixed, random effects, and hierarchical models Bayesian NMA for each outcome. Results We identified 18 RCTs and seven observational studies. Random models showed sulodexide is the best treatment compared with DOACs, VKA, and aspirin at reducing the risk of CRNMB, for preventing death from any cause, and VTE/PE/myocardial infarction (MI)/stroke with 0.47, 0.81, and 0.65 probabilities, respectively. In the random model sulodexide was the best treatment for reducing the risk of MB with a 0.50 probability and hierarchical model that confirmed favorable results. Random and hierarchical models showed sulodexide and DOACs to be the best treatments for reducing PE risk. Sulodexide was more effective than aspirin for reducing r-DVT with 0.12 and less of 0.0001 probabilities, respectively. Conclusion Sulodexide is more effective for reducing MB and CRNMB, for preventing deaths from any cause, and from VTE/PE/MI/stroke, than other treatments, for both random and hierarchical models. Sulodexide showed to be more effective than aspirin in reducing the risk of r-DVT and PE. Sulodexide's reduction in bleeding while protecting from recurrent DVT risk makes this therapeutic option an important alternative for extended anticoagulation treatment.

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“…Most post-marketing prospective or retrospective cohort studies assessing the efficacy and safety of NOACs for treatment of acute VTE also come from the Western countries. [17][18][19][20][21][22] In fact, little information is available about the treatment of VTE in Asia in recent years. There are also no published data that directly compare efficacy and safety in Asians with VTE who are treated with NOACs vs. warfarin.…”

mentioning

confidence: 99%

Changing Treatment Patterns in Patients With Venous Thromboembolism in Taiwan

Lee

Fang

Tsai

et al. 2020

Circ J

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Background: In Asia, little information is available about contemporary real-world treatment patterns for venous thromboembolism (VTE). Methods and Results: Consecutive patients (n=11,414) from the Taiwan National Health Insurance Research Database with initial VTE and taking oral anticoagulants between May 1, 2014 and June 30, 2016 were included. The temporal trends of using oral anticoagulants and pharmacomechanical therapy during the study period were evaluated. The efficacy and safety of nonvitamin K antagonist oral anticoagulants (NOACs) vs. warfarin were compared. Propensity score analysis (NOACs n=3,647 vs. warfarin n=3,647) was used to balance covariates between groups, and Cox proportional hazards models with adjustment were used to estimate the risks of clinical outcomes. The use of NOACs increased from 0.3% to 60.2% for VTE treatment during the study period. Pharmacomechanical therapy was used in 9.60%, 8.22%, and 5.63% from 2014 through 2016. NOACs were associated with a 16% risk reduction (adjusted hazard ratio [aHR] 0.84, 95% confidence interval [CI] 0.77-0.93) in all-cause mortality and a 21% risk reduction (aHR 0.79, 95% CI 0.65-0.96) in recurrent VTE vs. warfarin. Overall, NOACs were associated with a lower risk of major bleeding compared with warfarin (aHR 0.804, 95% CI 0.648-0.998). Conclusions: In real-world practice, NOACs have become the major anticoagulant used for Asians with VTE. Although NOACs had a lower risk of recurrent VTE and major bleeding compared with warfarin in Taiwan, we still need a large-scale randomized controlled trial to confirm the findings.

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Venous thromboembolism therapy with rivaroxaban in daily-care patients: Results from the Dresden NOAC registry

Cited by 22 publications

References 24 publications

Patient adherence to rivaroxaban in deep vein thrombosis, a cohort study in Switzerland: quantitative results

Patient adherence to rivaroxaban in deep vein thrombosis, a cohort study in Switzerland: quantitative results

Comparative Efficacy and Safety of Sulodexide and Other Extended Anticoagulation Treatments for Prevention of Recurrent Venous Thromboembolism: A Bayesian Network Meta-analysis

Changing Treatment Patterns in Patients With Venous Thromboembolism in Taiwan

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