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Safety and effectiveness of direct oral anticoagulants following ultrasound-assisted catheter directed thrombolysis for venous thromboembolism

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Abstract

Ultrasound-assisted catheter-directed thrombolysis (USAT) is a novel approach for the treatment of venous thromboembolism (VTE) that is thought to be associated with a decreased risk of bleeding. Direct oral anticoagulants (DOACs) are approved for the treatment of VTE but have not been studied in a post-fibrinolysis setting. The intention of this retrospective observational study was to determine the safety and effectiveness of DOACs compared to the vitamin-K-antagonist (VKA) warfarin following USAT in patients with documented VTE. Included patients were aged 18 years or older who had documented VTE and received oral anticoagulation with either a DOAC or VKA following USAT. The primary outcome of this study was to compare the 90-day composite incidence of major and minor bleeding and recurrent VTE between patients receiving DOACs after USAT to those receiving VKA after USAT. Similar rates of bleeding and recurrent VTE were observed (4/42; 9.5% in the DOAC group versus 2/34; 5.9% in the VKA group). The use of DOAC therapy post-USAT for VTE was not associated with higher rates of 90-day major or minor bleeding or 90-day recurrent VTE.

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References

  1. Søgaard KK, Schmidt M, Pedersen L, Horváth-Puhó E, Sørensen HT (2014) 30-year mortality after venous thromboembolism: a population-based cohort study. Circulation 130:829–836

    Article  PubMed  Google Scholar 

  2. Meyer G, Vicaut E, Danays T, Agnelli G, Becattini C, Beyer-Westendorf J et al (2014) Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 370:1402–1411

    Article  PubMed  CAS  Google Scholar 

  3. Kucher N, Boekstegers P, Müller OJ et al (2014) Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism. Circulation 129:479

    Article  PubMed  Google Scholar 

  4. Piazza G, Hohlfelder B, Jaff MR et al (2015) A prospective, single-arm, multicenter trial of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis for acute massive and submassive pulmonary embolism. The SEATTLE II study. J Am Coll Cardiol Intv 8:1382

    Article  Google Scholar 

  5. Barnes GD, Lucas E, Alexander GC, Goldberger ZD (2015) National trends in ambulatory oral anticoagulant use. Am J Med 128:1300–1305

    Article  PubMed  PubMed Central  Google Scholar 

  6. Schulman S, Kearon C, Kakkar AK, Mismetti P, Schellong S, Eriksson H et al (2009) Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med 361:2342–2352

    Article  PubMed  CAS  Google Scholar 

  7. Schulman S, Kakkar AK, Goldhaber SZ, Schellong S, Eriksson H, Mismetti P et al (2014) Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation 129:764–772

    Article  PubMed  CAS  Google Scholar 

  8. Bauersachs R, Berkowitz SD, Brenner B, Buller HR, Decousus H et al (2010) Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 363:2499–2510

    Article  PubMed  CAS  Google Scholar 

  9. Büller HR, Prins MH, Lensin AW, Decousus H, Jacobson BF et al (2012) Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med 366:1287–1297

    Article  PubMed  Google Scholar 

  10. Agnelli G, Buller HR, Cohen A, Curto M, Gallus AS, Johnson M et al (2013) Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med 369:799–808

    Article  PubMed  CAS  Google Scholar 

  11. Büller HR, Décousus H, Grosso MA, Mercuri M, Middeldorp S et al (2013) Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med 369:1406–1415

    Article  PubMed  CAS  Google Scholar 

  12. Schreinlechner M, Theurl M, Kirchmair R et al (2016) Anticoagulation with rivaroxaban after ultrasound-assisted catheter-directed thrombolysis in patients with intermediate high-risk pulmonary embolism—a case series. Interv Cardiol 8(6):1758–5310

    Article  Google Scholar 

  13. Xarelto (rivaroxaban) [Prescribing information] (2016). Janssen Pharmaceuticals Inc, Titusville

  14. Eliquis (apixaban) [Prescribing information] (2016). Bristol-Myers Squibb, Princeton

  15. Chesebro JH, Knatterud G, Roberts R et al (1987) Thrombolysis in Myocardial Infarction (TIMI) Trial, Phase I: a comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. Circulation 76:142–154

    Article  PubMed  CAS  Google Scholar 

  16. Sharifi M, Bay C, Schwartz F, Skrocki L (2014) Safe-dose thrombolysis plus rivaroxaban for moderate and severe pulmonary embolism: drip, drug, discharge. Clin Cardiol 37(2):78–82

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. University of Florida Health Jacksonville, University of Florida, 655 W 8th Street, C-89, Jacksonville, FL, 32209, USA

    Denise Kelley, Laurence Wright, Kelsey Ohman & Jason Ferreira

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  1. Denise Kelley
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  2. Laurence Wright
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  3. Kelsey Ohman
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  4. Jason Ferreira
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Correspondence to Denise Kelley.

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The authors have nothing to disclose concerning personal or financial relationships with commercial entities.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Institutional Review Board deemed informed consent not necessary for this study.

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Kelley, D., Wright, L., Ohman, K. et al. Safety and effectiveness of direct oral anticoagulants following ultrasound-assisted catheter directed thrombolysis for venous thromboembolism. J Thromb Thrombolysis 46, 58–61 (2018). https://doi.org/10.1007/s11239-018-1682-6

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  • DOI: https://doi.org/10.1007/s11239-018-1682-6

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