Fenling Fan1, Yuliang Zou2, Songlin Zhang3, Yushun Zhang3, Beidi Lan3, Qiang Song3, Meili Pei2, Lu He3, Huili Wu4, Yajuan Du3, Anthony M Dart5. 1. Department Cardiovascular Medicine, the First Hospital of Xi'an Jiaotong University, Xi'an, China; Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia; Department of Cardiovascular Medicine; The Alfred, Melbourne, Victoria, Australia. Electronic address: happyling@mail.xjtu.edu.cn. 2. Department Gynecology and Obstetrics, the First Hospital of Xi'an Jiaotong University, Xi'an, China. 3. Department Cardiovascular Medicine, the First Hospital of Xi'an Jiaotong University, Xi'an, China. 4. Department Oncology, the First Hospital of Xi'an Jiaotong University, Xi'an, China. 5. Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia; Department of Cardiovascular Medicine; The Alfred, Melbourne, Victoria, Australia.
Abstract
PURPOSE: Peripherally inserted central catheters (PICCs) are frequently used for prolonged drug administration, but their use is commonly complicated by the development of upper extremity deep venous thrombosis (UEDVT) requiring anticoagulation. Here, we compared the efficacy and safety profile of rivaroxaban (20 mg/d) with low molecular weight (LMW) heparin and vitamin K antagonists in the treatment of PICC-associated UEDVT. METHODS: Patients (N = 84) with PICC-associated UEDVT were studied. All had UEDVT identified by ultrasound scanning. Further ultrasound images were obtained at 1, 2, and 3 months after the start of treatment. Forty-four patients were treated with rivaroxaban and 40 with initial LMW heparin and vitamin K antagonist with continuation of vitamin K antagonists alone once international normalized ratio was therapeutic FINDINGS: In the rivaroxaban group mean (SD) age was 51 (16) years and 57% were men, whereas in the other group respective values were 50 (16) years and 56%. All patients were receiving treatment for cancer. Resolution of thrombus had occurred in 53.5% at 1 month, 76.1% at 2 months, and 92.6% at 3 months in the rivaroxaban-treated patients. Corresponding values in the LMW heparin/vitamin antagonist-treated patients were 34.2%, 55.5%, and 88.5%, respectively. Differences between groups were significant at 1 month (P < 0.01) and 2 months (P < 0.05). There were no major bleeds in either group, and cumulative bleeding rates by 3 months were 7.3% in the rivaroxaban group and 11.4% in the LMW heparin/vitamin K antagonist group. IMPLICATIONS: Rivaroxaban led to faster resolution of PICC-associated UEDVT than LMW/vitamin K antagonists without any increase in bleeding.
PURPOSE: Peripherally inserted central catheters (PICCs) are frequently used for prolonged drug administration, but their use is commonly complicated by the development of upper extremity deep venous thrombosis (UEDVT) requiring anticoagulation. Here, we compared the efficacy and safety profile of rivaroxaban (20 mg/d) with low molecular weight (LMW) heparin and vitamin K antagonists in the treatment of PICC-associated UEDVT. METHODS:Patients (N = 84) with PICC-associated UEDVT were studied. All had UEDVT identified by ultrasound scanning. Further ultrasound images were obtained at 1, 2, and 3 months after the start of treatment. Forty-four patients were treated with rivaroxaban and 40 with initial LMW heparin and vitamin K antagonist with continuation of vitamin K antagonists alone once international normalized ratio was therapeutic FINDINGS: In the rivaroxaban group mean (SD) age was 51 (16) years and 57% were men, whereas in the other group respective values were 50 (16) years and 56%. All patients were receiving treatment for cancer. Resolution of thrombus had occurred in 53.5% at 1 month, 76.1% at 2 months, and 92.6% at 3 months in the rivaroxaban-treated patients. Corresponding values in the LMW heparin/vitamin antagonist-treated patients were 34.2%, 55.5%, and 88.5%, respectively. Differences between groups were significant at 1 month (P < 0.01) and 2 months (P < 0.05). There were no major bleeds in either group, and cumulative bleeding rates by 3 months were 7.3% in the rivaroxaban group and 11.4% in the LMW heparin/vitamin K antagonist group. IMPLICATIONS: Rivaroxaban led to faster resolution of PICC-associated UEDVT than LMW/vitamin K antagonists without any increase in bleeding.
Authors: Angelo Porfidia; Giulia Cammà; Nicola Coletta; Margherita Bigossi; Igor Giarretta; Andrea Lupascu; Giuseppe Scaletta; Enrica Porceddu; Paolo Tondi; Giovanni Scambia; Gabriella Ferrandina; Roberto Pola Journal: Front Cardiovasc Med Date: 2022-06-28