Weekly risk of venous thromboembolism recurrence in patients receiving oral anticoagulants

Laliberté, François; Coleman, Craig I.; Bookhart, Brahim; Lefèbvre, Patrick; Cloutier, Michel; Damaraju, C.V.; Schein, Jeffery R.; Kaatz, Scott

doi:10.1185/03007995.2014.915801

Cited by 20 publications

(10 citation statements)

References 20 publications

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“… 33 34 35 36 37 Also, our definition for recurrent VTE is similar to ones used in prior evaluations. 38 39 40 41 Because, to the best of our knowledge, there are no recommendations or guidelines for defining CRNM bleeding in real-world studies, we defined CRNM bleeding as events that did not qualify as major bleeding and that did not involve ISTH-defined critical care sites. 42 …”

Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of Apixaban versus Warfarin as Outpatient Treatment of Venous Thromboembolism in U.S. Clinical Practice

Weycker

Wygant

et al. 2018

Thromb Haemost

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In the AMPLIFY clinical trial, apixaban was non-inferior to warfarin plus subcutaneous enoxaparin bridge therapy in the treatment of acute venous thromboembolism (VTE) and was associated with significantly less bleeding. This study evaluated their comparative effectiveness and safety in routine clinical practice. A matched-cohort design and data from four U.S. private health care claims databases were employed. Study population comprised patients who initiated outpatient treatment with apixaban versus warfarin (plus parenteral anticoagulant bridge therapy) within 30 days of their initial VTE episode; apixaban and warfarin patients were matched on age, characteristics of VTE episode, study database and propensity score. Major bleeding, clinically relevant non-major (CRNM) bleeding and recurrent VTE during the 180-day (maximum) follow-up period were compared using shared frailty models. During mean follow-up of 143 days among apixaban patients ( n = 17,878) and 152 days among warfarin patients ( n = 17,878), incidence proportions for apixaban versus warfarin, respectively, were 1.7% versus 2.3% for major bleeding, 7.0% versus 9.4% for CRNM bleeding and 2.3% versus 2.9% for recurrent VTE. In shared frailty models, risks of major bleeding (hazard ratio [HR] = 0.75, 95% confidence interval [CI] = 0.64–0.87), CRNM bleeding (HR = 0.77, 95% CI = 0.71–0.83) and recurrent VTE (HR = 0.80, 95% CI = 0.70–0.91) were lower for apixaban versus warfarin. In this large-scale evaluation of VTE patients receiving outpatient treatment with apixaban or warfarin in U.S. clinical practice, risks of major bleeding, CRNM bleeding and recurrent VTE were significantly lower among patients who received apixaban.

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Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of Apixaban versus Warfarin as Outpatient Treatment of Venous Thromboembolism in U.S. Clinical Practice

Weycker

Wygant

et al. 2018

Thromb Haemost

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“…Covariates for the adjusted models included age, sex, cancer type, region, race, calendar quarter of first VTE (eg, 2013Q1), setting in which the VTE was diagnosed (inpatient, outpatient, or emergency department), type of VTE (DVT, PE, or both), Charlson comorbidity index (CCI), and health care costs during the 6‐month baseline period before the index VTE. In addition, surgeries (ie, major surgery, abdominal surgery, and surgery‐provoked VTE [ie, neurosurgery or orthopedic surgery]) and other type of provoked VTEs (ie, trauma, acute spinal cord injury, fracture, estrogen therapy, pregnancy/postpartum state, or oral contraceptive use) in the 30 days prior to the index date were also included as covariates in the model.…”

Section: Methodsmentioning

confidence: 99%

Current practice patterns and patient persistence with anticoagulant treatments for cancer‐associated thrombosis

Khorana

McCrae

Milentijevic

et al. 2017

Research and Practice in Thrombosis and Haemostasis

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BackgroundRecommended therapeutic options for the management of venous thromboembolism (VTE) in patients with cancer are burdensome, and compliance with guidelines is unknown.ObjectivesTo describe current treatment patterns and to evaluate patient persistence on various anticoagulants.Patients/MethodsMedical and pharmacy claims from the Humana Database were analyzed (01/2007‐12/2014). Newly diagnosed cancer patients treated with anticoagulants were categorized into one of the following cohorts: low–molecular‐weight heparin (LMWH), warfarin, and rivaroxaban. Discontinuation, switching, and persistence with the index therapy were analyzed.ResultsA total of 2941 newly diagnosed patients with cancer who developed VTE and received anticoagulation in outpatient settings were identified. Of these, 97% initiated anticoagulation with LMWH (n=735; 25%), warfarin (n=1403; 47.7%), or rivaroxaban (n=709; 24.1%). Median treatment durations for the LMWH, warfarin, and rivaroxaban cohorts were 3.3, 7.9, and 7.9 months, respectively; Kaplan‐Meier rates of persistence to the initial therapy were 37%, 61%, and 61% at 6 months. Warfarin and rivaroxaban users were significantly more likely to remain on initial therapy compared to LMWH (adjusted hazard ratios [HRs; 95% CI]: warfarin, 0.33 [0.28‐0.38]; rivaroxaban, 0.38 [0.32‐0.46]). The proportion of patients that switched from their initial treatment to another anticoagulation treatment was 22.9%, 7.9%, and 4.7% in the LMWH, warfarin, and rivaroxaban cohorts, respectively.ConclusionsThis real‐world analysis showed that, despite guideline recommendations, warfarin and rivaroxaban are at least as equally utilized as LMWH for the treatment of cancer‐associated thrombosis. LMWH was associated with significantly lower persistence, shorter duration of treatment, and more switching than warfarin and rivaroxaban.

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“…64,66 For both rivaroxaban and apixaban, higher doses are used in the immediate peri-clot period to halt extension of the existing clot and prevent recurrent VTE, as risk of recurrence is highest in the first two weeks. 63,65,67 Several other populations of interest may lead to selection of one DOAC over another (Table 3). Rivaroxaban and apixaban are both renally excreted (36% and 27% renal excretion, respectively) and patients with CrCL less than 30 ml/min were excluded from SELECT-D, ADAM-VTE, and CARAVAGGIO.…”

Section: Doac Selection For Cancer-associated Vtementioning

confidence: 99%

Clinical controversies in the treatment of cancer-associated venous thromboembolism

Nachar

Schepers

2021

J Oncol Pharm Pract

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Cancer-associated venous thromboembolism (VTE) is a common complication of malignancy. Patients with cancer exhibit risk factors for both recurrent VTE and major or minor bleeding. Direct oral anticoagulants (DOACs) are an attractive treatment option; however, there is a lack of consensus among national guidelines for choice between DOACs and LMWH, agent selection, dosing strategy, and duration of anticoagulation. Characteristics of the thrombotic event, the malignancy, the patient, and the anticoagulant must be considered. A systematic search of online databases was performed to identify literature on the management of cancer-associated VTE. Multiple controversies remain surrounding the optimal treatment of cancer-associated VTE.

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Weekly risk of venous thromboembolism recurrence in patients receiving oral anticoagulants

Abstract: This analysis suggests that the risk of VTE recurrence remains high in the early weeks after an index VTE among patients receiving anticoagulants.

Cited by 20 publications

References 20 publications

Effectiveness and Safety of Apixaban versus Warfarin as Outpatient Treatment of Venous Thromboembolism in U.S. Clinical Practice

Effectiveness and Safety of Apixaban versus Warfarin as Outpatient Treatment of Venous Thromboembolism in U.S. Clinical Practice

Current practice patterns and patient persistence with anticoagulant treatments for cancer‐associated thrombosis

Clinical controversies in the treatment of cancer-associated venous thromboembolism

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