Venous thromboembolism management in Northeast Melbourne: how does it compare to international guidelines and data?

Lim, Hui Yin; Chua, Chong Chyn; Tacey, Mark; Sleeman, Matthew A.; Donnan, Geoffrey A; Nandurkar, Harshal; Ho, Prahlad

doi:10.1111/imj.13525

Cited by 10 publications

(8 citation statements)

References 27 publications

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“…Although these disorders are found in~5-10% of patients with a first VTE incident, they may not be independent risk factors for recurrent thrombosis. After adjustment for age, sex, and anticoagulant use, these thrombophilia disorders are only associated with a relatively low (~1.5-fold increase) risk of VTE recurrence compared to their non-thrombophilia patient counterparts [36][37][38][39]. Observations from recent case reports and case series on efficacy of DOACs in patients with FVL or PT G20210A mutation are mostly in line with our favorable subgroup analysis results, supporting the use of DOACs in these low-risk thrombophilias (Table S5) [40][41][42][43][44][45][46][47][48][49].…”

Section: Discussionmentioning

confidence: 99%

Direct oral anticoagulants in patients with venous thromboembolism and thrombophilia: a systematic review and meta‐analysis

Elsebaie

Langston

et al. 2019

Journal of Thrombosis and Haemostasis

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We investigated direct oral anticoagulant (DOAC) use in venous thromboembolism and thrombophilia. A comprehensive search identified 10 studies, 8 of which were included in a meta‐analysis. DOACs were overall safe and effective in patients with venous thromboembolism and thrombophilia. Efficacy/safety of DOACs was maintained in low‐risk antiphospholipid syndrome patient subgroup. Summary BackgroundDirect oral anticoagulants (DOACs) are increasingly used in acute and long‐term treatment of venous thromboembolism (VTE). However, their role in management of thrombophilia‐associated VTE is controversial. MethodsThrough a comprehensive search on MEDLINE, Cochrane Library, and Clinicaltrials.gov, we identified 10 eligible studies, 8 of which reporting data on 1994 thrombophilia patients were included in a random‐effects meta‐analysis. Eligible studies were phase 2 to 3 randomized controlled trials comparing DOACs to vitamin K antagonists (VKAs) in patients with VTE, including those with thrombophilia. ResultsOf eight studies included in meta‐analysis, four evaluated rivaroxaban, three dabigatran, and one edoxaban. No results could be obtained on apixaban use. The rates of VTE recurrence (RR, 0.70; 95% CI, 0.34–1.44; I2 = 0%) and major/clinically relevant non‐major bleeding events (RR, 0.92; 95% CI, 0.62–1.36; I2 = 23%) were similar between thrombophilia patients treated with DOACs compared to VKAs. Results were comparable to findings in patients without known thrombophilia: RR, 1.02; 95% CI, 0.80–1.30; I2 = 46% for VTE recurrence and RR, 0.72; 95% CI, 0.57–0.90; I2 = 84% for major/clinically relevant non‐major bleeding events. ConclusionsRates of VTE recurrence and bleeding events were both low and comparable in patients with various thrombophilias receiving either treatment, suggesting that DOACs are an appropriate treatment option in this population. Due to limited data, it is unclear whether these findings apply to specific subgroups such as high‐risk antiphospholipid syndrome, uncommon thrombophilias, or the use of apixaban.

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Section: Discussionmentioning

confidence: 99%

Direct oral anticoagulants in patients with venous thromboembolism and thrombophilia: a systematic review and meta‐analysis

Elsebaie

Langston

et al. 2019

Journal of Thrombosis and Haemostasis

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“…It should be noted that, although most patients with PNH experience intravascular haemolysis and its associated risks, the requirement for transfusion is dependent not only on the degree of haemolysis but also on how well the bone marrow is capable of compensating for the loss. 13,22,23 Additionally, other factors, such as patient symptoms, physician practice patterns and local policies, impact the decision on whether to transfuse a particular patient.…”

Section: Discussionmentioning

confidence: 99%

Clinical benefit of eculizumab in patients with no transfusion history in the International Paroxysmal Nocturnal Haemoglobinuria Registry

Almeida¹,

Bedrosian

Cole

et al. 2017

Internal Medicine Journal

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“…Our recent real-life VTE audit of more than 1,000 patients has shown that VTE recurrence rates remain substantial in patients with isolated distal DVT (IDDVT) and in those with minimally provoked VTE. 20 We demonstrated that VTE recurrence rates in the IDDVT population (16/166, 10%) were similar to those in major VTE (41/586, 7%; p ¼ 0.36), with 60% of patients with IDDVT suffering major recurring VTE. 21 Similarly, VTE recurrence risk remained substantial in patients with provoked VTE, especially in those due to nonsurgically related causes (3.4 per 100 person-years), and of note, patients with minimally provoked VTE, such as long travels, had similar recurrence rate compared with those with unprovoked VTE (5.8 vs. 4.6 per 100 person-years; RR: 1.30; 95% CI: 0.61-2.79; p ¼ 0.50).…”

Section: Clinical Risk Assessmentmentioning

confidence: 50%

Direct Oral Anticoagulants and the Paradigm Shift in the Management of Venous Thromboembolism

Lim

Nandurkar

2018

Semin Thromb Hemost

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The advent of direct oral anticoagulants (DOACs) has revolutionized anticoagulation management in both stroke prevention and venous thromboembolism (VTE) treatment/prevention. Clinical trials and secondary real-world data have shown that DOACs have similar efficacy and, in some cases, improved bleeding safety profiles compared with vitamin K antagonists. Together with benefits of patient convenience, this has shifted the risk-benefit ratio toward long-term anticoagulation. However, current VTE risk assessment models are based on vitamin K antagonists and do not take into account the new paradigm of DOACs. Therefore, challenges to the thrombosis community remain to determine patients who would benefit from long-term anticoagulation in the DOAC era. Here, the authors review the current literature on risks and benefits of DOACs and their potential role in long-term VTE thromboprophylaxis as well as in current risk assessment models. The increasing use of DOACs, led by their convenience of use and generally lower bleeding rates, calls for a reevaluation of the current models as the benefits of long-term anticoagulation may begin to outweigh risks and inconvenience associated with their predecessors.

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Venous thromboembolism management in Northeast Melbourne: how does it compare to international guidelines and data?

Cited by 10 publications

References 27 publications

Direct oral anticoagulants in patients with venous thromboembolism and thrombophilia: a systematic review and meta‐analysis

Direct oral anticoagulants in patients with venous thromboembolism and thrombophilia: a systematic review and meta‐analysis

Clinical benefit of eculizumab in patients with no transfusion history in the International Paroxysmal Nocturnal Haemoglobinuria Registry

Direct Oral Anticoagulants and the Paradigm Shift in the Management of Venous Thromboembolism

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