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Direct Oral Anticoagulants for Pulmonary Embolism: Importance of Anatomical Extent
- Source :
- TH Open, Vol 02, Iss 01, Pp e1-e7 (2018)
- Publication Year :
- 2018
- Publisher :
- Georg Thieme Verlag KG, 2018.
-
Abstract
- Pulmonary embolism (PE) studies used direct oral anticoagulants (DOACs) with or without initial heparin. We aimed to (1) evaluate if PE patients benefit from initial heparin; (2) describe patient characteristics in the DOAC studies; and (3) investigate whether the anatomical extent of PE correlates with N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, cause of PE, and recurrence rate. Our methods were (1) an indirect meta-analysis comparing the recurrence risk in DOAC-treated patients with or without initial heparin to those patients given heparin/vitamin K antagonist (VKA). (2) To compare the PE studies, information was extracted on baseline characteristics including anatomical extent. (3) The Hokusai-VTE study was used to correlate anatomical extent of PE with NT-proBNP levels, causes of PE, and recurrent venous thromboembolism (VTE). The meta-analysis included 11,539 PE patients. The relative risk of recurrent VTE with DOACs versus heparin/VKAs was 0.8 (95% confidence interval [CI]: 0.6–1.1) with heparin lead-in and 1.1 (95% CI: 0.8–1.5) without heparin. In the DOAC studies, the proportion of patients with extensive PE varied from 24 to 47%. In Hokusai-VTE, NT-proBNP was elevated in 4% of patients with limited and in over 60% of patients with extensive disease. Cause of PE and anatomical extent were not related. Recurrence rates increased from 1.6% with limited to 3.2% with extensive disease in heparin/edoxaban-treated patients, and from 2.4 to 3.9% in heparin/warfarin recipients. In conclusion, indirect evidence suggests a heparin lead-in before DOACs may be advantageous in PE. Anatomical extent was related to elevated NT-proBNP and outcome, but not to PE cause.
Details
- Language :
- English
- ISSN :
- 25129465
- Volume :
- 02
- Issue :
- 01
- Database :
- Directory of Open Access Journals
- Journal :
- TH Open
- Publication Type :
- Academic Journal
- Accession number :
- edsdoj.834b7b370e214a23b27ecd10f0a037ed
- Document Type :
- article
- Full Text :
- https://doi.org/10.1055/s-0037-1615251