Clinical outcomes in lower extremity deep vein thrombosis treated with a direct oral anticoagulant: A retrospective cohort study
Keywords:Deep vein thrombosis, Direct oral anticoagulant, Apixaban, Recurrence, Pulmonary embolism, Anticoagulation
Background/Aim: Rivaroxaban and apixaban were shown to be non-inferior and somewhat superior to warfarin in preventing pulmonary embolization and venous complications. However, there is still a need for further evidence concerning the efficacy and safety of direct oral anticoagulants in the treatment of patients with deep vein thrombosis (DVT) and pulmonary embolism (PE). This study aimed to analyze patients with DVT and PE who received a direct oral anticoagulant (apixaban) during their hospitalization and thereafter. Methods: Data of all consecutive subjects admitted for lower limb DVT who received apixaban for DVT treatment in our department between January 2015-April 2019 were analyzed. Apixaban was directly administered after the diagnosis of DVT in 68 subjects, following discontinuation of warfarin due to the lack of success in maintaining appropriate INR values in 56 subjects and following the discontinuation of the rivaroxaban due to gastrointestinal complications in 7 subjects. Results: Apixaban was administered for a median duration of 12.0 (12.0-24.0) months. The most common predisposing factors for venous thromboembolism were thrombophilia and major surgery history. Among all, 62.59% of the DVT were at and proximal to the femoral vein. Concomitant PE was encountered in 16.03% of the study subjects. Those with distal DVT and those who received apixaban immediately after diagnosis of the DVT less frequently developed PE compared to those who received post-rivaroxaban or post-warfarin apixaban. Treatment with apixaban leads to a significant decline in D-dimer levels from the first month of the treatment (P<0.001). Recurrent DVT and PE occur in 10% and 16%, respectively, under apixaban treatment. Conclusions: Among patients with proximal DVT, those receiving apixaban following a period of treatment with rivaroxaban or warfarin compared to direct administration constitute the majority of the PE cases. Apixaban seems like an effective treatment option in patients with DVT and PE.
Wilbur J, Shian B. Deep Venous Thrombosis and Pulmonary Embolism: Current Therapy. Am Fam Physician. 2017;95(5):295-302.
Atılgan K, Demirdaş E, Er CZ, Çiçekçioğlu F. Evaluation of deep vein thrombosis incidence with respect to age and gender in light of regional factors in central Anatolia: A population-based study. Menopause. 2020;4(7):9-10.
Giordano NJ, Jansson PS, Young MN, Hagan KA, Kabrhel C. Epidemiology, Pathophysiology, Stratification, and Natural History of Pulmonary Embolism. Tech Vasc Interv Radiol. 2017;20(3):135-40. doi: 10.1053/j.tvir.2017.07.002.
Spandorfer J, Galanis T. In the Clinic. Deep venous thrombosis. Ann Intern Med. 2015;162(9):Itc1. doi: 10.7326/aitc201505050.
Thachil J. Deep vein thrombosis. Hematology. 2014;19(5):309-10. doi: 10.1179/1024533214z.000000000284.
Stoeva N, Staneva M, Kirova G, Bakalova R. Deep venous thrombosis in the clinical course of pulmonary embolism. Phlebology. 2019;34(7):453-8. doi: 10.1177/0268355518819510.
Di Nisio M, Van Es N, Büller HR. Deep vein thrombosis and pulmonary embolism. Lancet. 2016;388(10063):3060-73. doi: 10.1016/s0140-6736(16)30514-1.
Stubbs MJ, Mouyis M, Thomas M. Deep vein thrombosis. BMJ. 2018;360(k351. doi: 10.1136/bmj.k351.
Schulman S, Konstantinides S, Hu Y, Tang LV. Venous Thromboembolic Diseases: Diagnosis, Management and Thrombophilia Testing: Observations on NICE Guideline [NG158]. Thromb Haemost. 2020;120(8):1143-6. doi: 10.1055/s-0040-1712913.
Bauersachs R, Berkowitz SD, Brenner B, Buller HR, Decousus H, Gallus AS, et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010;363(26):2499-510. doi: 10.1056/NEJMoa1007903.
Agnelli G, Buller HR, Cohen A, Curto M, Gallus AS, Johnson M, et al. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med. 2013;369(9):799-808. doi: 10.1056/NEJMoa1302507.
Ramaswamy RS, Akinwande O, Giardina JD, Kavali PK, Marks CG. Acute Lower Extremity Deep Venous Thrombosis: The Data, Where We Are, and How It Is Done. Tech Vasc Interv Radiol. 2018;21(2):105-12. doi: 10.1053/j.tvir.2018.03.006.
Messas E, Wahl D, Pernod G. Management of deep-vein thrombosis: A 2015 update. J Mal Vasc. 2016;41(1):42-50. doi: 10.1016/j.jmv.2015.07.105.
Yin SW, Guo LW, Bian L, Xiang TM, Pan SQ. Evaluation of Percutaneous Mechanical Thrombectomy via the AngioJet System Combined with Catheter-Directed Thrombolysis for the Treatment of Symptomatic Lower Extremity Deep Venous Thrombosis. Ann Vasc Surg. 2020;65(66-71. doi: 10.1016/j.avsg.2019.11.014.
Kearon C, Akl EA. Duration of anticoagulant therapy for deep vein thrombosis and pulmonary embolism. Blood. 2014;123(12):1794-801. doi: 10.1182/blood-2013-12-512681.
Krutman M, Kuzniec S, Ramacciotti E, Varella AY, Zlotnik M, Teivelis MP, et al. Rediscussing Anticoagulation in Distal Deep Venous Thrombosis. Clin Appl Thromb Hemost. 2016;22(8):772-8. doi: 10.1177/1076029615627343.
Jacobs B, Henke PK. Evidence-Based Therapies for Pharmacologic Prevention and Treatment of Acute Deep Vein Thrombosis and Pulmonary Embolism. Surg Clin North Am. 2018;98(2):239-53. doi: 10.1016/j.suc.2017.11.001.
Büller HR, Prins MH, Lensin AW, Decousus H, Jacobson BF, Minar E, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012;366(14):1287-97. doi: 10.1056/NEJMoa1113572.
General OOTS, National Heart L, Institute B. The Surgeon General's call to action to prevent deep vein thrombosis and pulmonary embolism. 2008.
Kafeza M, Shalhoub J, Salooja N, Bingham L, Spagou K, Davies AH. A systematic review of clinical prediction scores for deep vein thrombosis. Phlebology. 2017;32(8):516-31. doi: 10.1177/0268355516678729.
- 167 364
How to Cite
Copyright (c) 2021 Rukiye Derin Atabey, Yigit Akcali
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.