Early, real-world experience with direct oral anticoagulants in the treatment of intermediate-high risk acute pulmonary embolism

• Autor(a) principal: Santos, Sónia Martins
• Data de Publicação: 2017
• Outros Autores: Cunha, Susana, Baptista, Rui, Monteiro, Sílvia, Monteiro, Pedro, Gonçalves, Francisco, Pêgo, Mariano
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10316/102117; https://doi.org/10.1016/j.repc.2017.01.010
• topic: Anticoagulants; Venous thromboembolism; Real world; Pulmonary embolism; Intermediate-high risk; Warfarin; CHAVEAnticoagulantes; Tromboembolismovenoso; Mundo real; Embolia pulmonar; Risco intermédio aelevado; VarfarinaExperiência; Administration, Oral; Adult; Aged; Aged, 80 and over; Anticoagulants; Cohort Studies; Female; Humans; Male; Middle Aged; Pulmonary Embolism; Retrospective Studies; Risk Assessment; Warfarin; Young Adult

Introduction: Intermediate-high risk pulmonary embolism (IHR-PE) has a poor prognosis, but is under-represented in trials of direct oral anticoagulants (DOACs) in venous thromboembolic disease (VTE). We aimed to assess whether the administration of DOACs was equivalent to the conventional (CONV) treatment of low-molecular weight heparin bridged with warfarin for treating IHR-PE. Methods: We conducted a retrospective cohort study including 59 consecutive patients admitted with IHR-PE and followed for up to three months after discharge. Two groups were created based on the anticoagulant strategy: CONV (n=35) and DOAC (n=24). The efficacy endpoints were death, recurrent PE, estimated pulmonary artery systolic pressure (PASP), right ventricular systolic function (RVSF) at discharge, and length of stay; the safety endpoint was major bleeding. Results: The two groups were similar regarding demographics, PE etiology and markers of clinical severity. There were four in-hospital deaths in the CONV group and none in the DOAC group. No recurrent PE or major bleeding event was recorded in either group. At discharge, neither PASP nor RVSF was different between the groups. Patients in the DOAC group were discharged 1.7 days earlier on average than patients in the CONV group (4.7±2.4 vs. 3.0±1.5 days, p=0.002). Conclusions: The adoption of a DOAC treatment strategy in this real-world cohort of IHR-PE patients was associated with similar efficacy and safety to the CONV approach. The fact that monitoring of anticoagulation effect was unnecessary probably led to the significant reductionin length of stay.