Non-recommended dosing of direct oral anticoagulants in the treatment of acute pulmonary embolism is related to an increased rate of adverse events at 6 months - 25/12/18
, S. Humbert 1, N. Falvo 2, M. Morel 3, B. Bonnet 4, G. Napporn 5, E. Kalbacher 6, L. Obert 7, B. Degano 8, G. Capellier 9, Y. Cottin 10, F. Schiele 1, N. Meneveau 1Bienvenue sur EM-consulte, la référence des professionnels de santé.
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Résumé |
Background |
Dose adjustment of direct oral anticoagulants (DOACs) is not required in the setting of acute pulmonary embolism (PE) treatment according to the manufacturer's labelling, apart from a contraindication in patients with a creatinine clearance <30mL/min. The present study aimed to investigate the impact of non-recommended DOAC dose prescription on 6-month adverse events.
Methods |
This is an observational, multicenter, multidisciplinary registry of acute PE from 09/2012 to 10/2016. The primary endpoint was a composite of all-cause death, recurrent venous thromboembolism (VTE), major bleeding, and chronic thromboembolic pulmonary hypertension (CTEPH).
Results |
During the study period, 656 patients were discharged with DOACs (rivaroxaban: 614 patients (93.6%); apixaban 42 patients (6.4%)). Mean age was 63.6±17.9 years, 46.9% were males. Overall, 628 (95.7%) were treated with the recommended dose of DOACs, and 28 (4.3%) were not. During the course of therapy, 16 patients died, 10 presented VTE, 11 had major bleeding, and 12 developed CTEPH. The primary composite endpoint occurred in 7/28 patients (25.0%) in the non-recommended dose group and in 38/628 patients (6.1%) in the recommended dose group, yielding a relative risk of 3.19 in the non-recommended dose group (95% CI: 1.16–8.70; P<0.001). The higher primary endpoint rate observed in the non-recommended dose group was driven by a significantly higher rate of major bleeding (P=0.008), with a non-significant trend toward higher rates of death (P=0.23), recurrent VTE (P=0.31), and CTEPH (P=0.32) (Figure 1).
Conclusions |
Empiric dose reduction of DOACs was associated with an increased risk of 6-month adverse events in our real-life registry.
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Vol 11 - N° 1
P. 98-99 - janvier 2019 Retour au numéro
Article précédent
- Blood pressure variability and target organ damage in hypertensive patients in the area of Blida (Algeria)
- A. Bachir Cherif, M. Temmar, N. Dammene Debbih, S. Bennouar, A. Taleb, M.T. Bouafia
- Prognostic impact of non-compliance with guidelines-recommended treatment of acute pulmonary embolism: Results of a prospective multicenter registry
- R. Chopard, Lisbeth Cart, S. Humbert, N. Falvo, M. Morel-Aleton, B. Bonnet, G. Napporn, E. Kalbacher, L. Obert, B. Degano, G. Capellier, Y. Cottin, François Schiele, N. Meneveau
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