Efficacy and safety of direct oral anticoagulants in intermediate-high risk pulmonary embolism: Results from a multidisciplinary multicenter prospective registry - 17/04/19
Résumé |
Background |
Data on the initiation of direct oral anticoagulants (DOAC) in patients with intermediate-high risk pulmonary embolism (PE) are lacking. We conducted a prospective multicentre multidisciplinary registry study aimed at:
– describing the antithrombotic strategy in real-life practice at the acute phase of intermediate-high risk PE;
– assessing efficacy and safety of DOACs vs. standard guidelines-recommended anticoagulation therapy.
Methods |
We enrolled all pts with acute PE hospitalized in 11 participating centers. Intermediate-high risk PE was defined according to the ESC guidelines (hemodynamic stability, echocardiographic signs of RV dysfunction, elevated cardiac biomarkers). Early prescription of DOAC was defined as DOAC-prescription within 24h after PE diagnosis. Primary outcome was a clinical composite of in-hospital death from any cause and hemodynamic decompensation. All pts were followed for at least 6 months.
Results |
From 09/2012 to 12/2016, 1056 pts were enrolled. Among 249 (23.6%) intermediate-high risk PE pts, 40 (16.1%) received DOAC and 209 (83.9%) received parenteral anticoagulation in the first 24h. Active cancer and impaired kidney function were independently related to non-prescription of DOAC. NYHA functional class I or II was the only factor independently associated with use of DOAC. There was no difference between groups in terms of death or hemodynamic decompensation in-hospital (OR 0.18; 95% CI 0.02 to 1.39; P=0.01). The rate of in-hospital death, hemodynamic decompensation, bleeding, and recurrent PE were also similar. At 6 months, groups did not differ significantly in terms of death, recurrent PE, bleeding, MI or stroke.
Conclusion |
Our registry suggests that DOACs are quite frequently given as initial treatment in the first 24h after diagnosis in intermediate-high risk PE pts in clinical practice with promising safety and efficacy profiles compared to standard guidelines-recommended parenteral anticoagulation.
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Vol 11 - N° 1P2
P. e297 - avril 2019 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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