Rivaroxaban and Apixaban for Initial Treatment of Acute Venous Thromboembolism of Atypical Location

被引:86
|
作者
Janczak, Dawid T. [1 ]
Mimier, Malgorzata K. [2 ]
McBane, Robert D. [3 ]
Kamath, Patrick S. [4 ]
Simmons, Benjamin S. [3 ]
Bott-Kitslaar, Dalene M. [3 ]
Lenz, Charles J. [3 ]
Vargas, Emily R. [5 ]
Hodge, David O. [5 ]
Wysokinski, Waldemar E. [3 ]
机构
[1] Wroclaw Med Univ, Fac Hlth Sci, Div Oncol & Palliat Care, Wroclaw, Poland
[2] Wroclaw Med Univ, Dept & Clin Ophthalmol, Wroclaw, Poland
[3] Mayo Clin, Div Cardiovasc Med, 200 SW First St, Rochester, MN 55905 USA
[4] Mayo Clin, Div Gastroenterol & Hepatol, Rochester, MN USA
[5] Mayo Clin, Dept Hlth Sci Res, Jacksonville, FL 32224 USA
关键词
PORTAL-VEIN THROMBOSIS; DIRECT ORAL ANTICOAGULANTS; SYMPTOMATIC PULMONARY-EMBOLISM; RISK-FACTORS; CIRRHOSIS; EFFICACY; THERAPY; DISEASE; SAFETY; ASSOCIATION;
D O I
10.1016/j.mayocp.2017.10.007
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives: To assess the outcome of direct oral anticoagulants (DOACs), specifically Xa inhibitors: rivaroxaban and apixaban, for the treatment of venous thromboembolism (VTE) of atypical location (VTE-AL), portal, mesenteric, hepatic, splenic, gonadal, renal, and cerebral veins, prospectively collected data of Mayo Thrombophilia Clinic Registry were used. Methods: Patients with acute VTE-AL treated with DOACs, enrolled between March 1, 2013, and February 1, 2017, were compared with patients with VTE of typical location (VTE-TL: deep vein thrombosis of extremities and/or pulmonary embolism) receiving DOACs and with patients with VTE-AL treated with enoxaparin. Results: Out of 623 patients with acute VTE receiving the study drug within 14 days of diagnosis, there were 63 with VTE-AL: 36 on DOAC, 23 on enoxaparin, and 4 on warfarin; 352 received DOAC for VTE-TL. The VTE-AL treated with DOAC/enoxaparin included the following: splanchnic (26/22), ovarian (8/2), renal (3/5), and cerebral veins (1/1), respectively. Recurrence rate (per 100 person-years) for the VTE-AL group receiving DOAC was 7.3, which was not different when compared with those for VTE-TL (2.4; P = .13) and VTE-AL groups receiving enoxaparin (23.7; P = .37). Major bleeding rate in the VTE-AL group receiving DOAC was not different compared with those for VTE-TL (7.2 vs 3.0; P = .26) and VTE-AL groups on enoxaparin (22.4; P = .31). Mortality was higher in the VTE-AL group on DOAC compared with the VTE-TL group (21.45 [95% CI, 7.87-46.69] vs 8.26 [95% CI, 5.35, 12.20]; P = .03). All patients with VTE-AL with events had cancer. Conclusion: The VTE recurrence and bleeding rates for rivaroxaban and apixaban used in VTE-AL are not different from those in patients with VTE-TL and similar to that for enoxaparin. (C) 2017 Mayo Foundation for Medical Education and Research
引用
收藏
页码:40 / 47
页数:8
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