The effect of off-label use of reduced-dose direct oral anticoagulants therapy in the treatment of pulmonary embolism comparable to standard-dose therapy
-
Published:2024-02-21
Issue:4
Volume:39
Page:365-372
-
ISSN:0910-8327
-
Container-title:Heart and Vessels
-
language:en
-
Short-container-title:Heart Vessels
Author:
Yamazoe Shinji, Imai HajimeORCID, Ogawa Yasuhiro, Kano Naoaki, Murase Yosuke, Mamiya Keita, Ikeda Tomoyo, Hiramatsu Kei, Torii Jun, Kawaguchi Katsuhiro
Abstract
AbstractDirect oral anticoagulants (DOACs) have been shown to be effective and safe in preventing pulmonary embolism recurrence. In this single-center retrospective observational study, we aimed to evaluate the efficacy and safety of reduced-dose DOACs in 86 consecutive patients with acute pulmonary embolism. Patients were divided into standard-dose and reduced-dose DOACs groups. Initial clot volume did not significantly differ between the two groups (standard-dose DOACs vs. reduced-dose DOACs, 18.8 [Q1–Q3 7.3–30.8] mL vs. 10.0 [Q1–Q3 3.2–27.9] mL, p = 0.1). Follow-up computed tomography (CT) within 30 days showed a higher rate of clot volume reduction or disappearance in the standard-dose group compared to the reduced-dose group (standard-dose DOACs vs. reduced-dose DOACs, 81.6% vs. 53.9%, p = 0.02). However, at the final follow-up CT, there was no significant difference in clot volume change between the two groups (standard-dose DOACs vs. reduced-dose DOACs, 91.5% vs. 82.0%, p = 0.19). Major bleeding occurred in two patients in the standard-dose group (4.3%) and three patients in the reduced-dose DOACs group (7.7%) (p = 0.5). In conclusion, while standard-dose DOACs demonstrated superior efficacy in early clot reduction, reduced doses of apixaban and edoxaban showed comparable efficacy and safety profiles in long-term treatment of acute pulmonary embolism in certain patients.
Publisher
Springer Science and Business Media LLC
Reference31 articles.
1. Schulman S, Kearon C, Kakkar AK, Mismetti P, Schellong S, Eriksson H, Baanstra D, Schnee J, Goldhaber SZ (2009) Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med 361(24):2342–2352 2. Büller HR, Prins MH, Lensin AW, Decousus H, Jacobson BF, Minar E, Chlumsky J, Verhamme P, Wells P, Agnelli G, Cohen A, Berkowitz S, Bounameaux H, Davidson BL, Misselwitz F, Gallus AS, Raskob GE, Shellong S, Segers A (2012) Oral rivaroxaban for the treatment of symptomatic Pulmonary Embolism. N Engl J Med 366(14):1287–1297 3. Agnelli G, Buller HR, Cohen A, Curto M, Gallus AS, Johnson M, Masiukiewicz U, Pak R, Thompson J, Raskob GE, Weitz JI (2013) Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med 369(9):799–808 4. Büller HR, Décousus H, Grosso MA, Mercuri M, Middeldorp S, Prins MH, Raskob GE, Schellong SM, Schwocho L, Segers A, Shi M, Verhamme P, Wells P (2013) Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med 369(15):1406–1415 5. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, HuismanMV, Humbert M, Jennings CS, Jiméne D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Áinle FN, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL (2019) 2019 ESC guidelines for the diagnosis and management of acute Pulmonary Embolism developed in collaboration with the European Respiratory Society (ERS): the Task Force for the diagnosis and management of acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Respir J 54(3)
|
|