Mette Søgaard1, Peter Brønnum Nielsen2, Flemming Skjøth3, Jette Nordstrøm Kjældgaard2, Craig I Coleman4, Torben Bjerregaard Larsen2. 1. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark. Electronic address: mette.soegaard@rn.dk. 2. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark. 3. Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark; Unit for Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark. 4. School of Pharmacy, University of Connecticut, Storrs.
Abstract
BACKGROUND: The effectiveness of rivaroxaban to reduce post-thrombotic syndrome in patients with venous thromboembolism is largely unknown. We compared rates of post-thrombotic syndrome in patients given rivaroxaban versus warfarin in a cohort of patients with incident venous thromboembolism receiving routine clinical care. METHODS: We linked Danish nationwide registries to identify all patients with incident venous thromboembolism who were new users of rivaroxaban or warfarin and compared rates of post-thrombotic syndrome using an inverse probability of treatment-weighting approach to account for baseline confounding. RESULTS: We identified 19,957 oral anticoagulation-naive patients with incident venous thromboembolism treated with warfarin or rivaroxaban (mean age, 64 years; 48% were female, 45.5% had pulmonary embolism). The propensity-weighted rate of post-thrombotic syndrome at 3 years follow-up was 0.53 incidents per 100 person-years with rivaroxaban versus 0.55 per 100 person-years with warfarin, yielding a hazard rate of 0.88 (95% confidence interval, 0.66-1.17). This association remained consistent across types of venous thromboembolism (deep venous thrombosis vs pulmonary embolism, and provoked vs unprovoked venous thromboembolism) and when censoring patients with recurrent venous thromboembolism. CONCLUSIONS: In this clinical practice setting, rivaroxaban was associated with lower but statistically nonsignificant rates of post-thrombotic syndrome, which did not appear to be mediated only by an effect on recurrent venous thromboembolism.
BACKGROUND: The effectiveness of rivaroxaban to reduce post-thrombotic syndrome in patients with venous thromboembolism is largely unknown. We compared rates of post-thrombotic syndrome in patients given rivaroxaban versus warfarin in a cohort of patients with incident venous thromboembolism receiving routine clinical care. METHODS: We linked Danish nationwide registries to identify all patients with incident venous thromboembolism who were new users of rivaroxaban or warfarin and compared rates of post-thrombotic syndrome using an inverse probability of treatment-weighting approach to account for baseline confounding. RESULTS: We identified 19,957 oral anticoagulation-naive patients with incident venous thromboembolism treated with warfarin or rivaroxaban (mean age, 64 years; 48% were female, 45.5% had pulmonary embolism). The propensity-weighted rate of post-thrombotic syndrome at 3 years follow-up was 0.53 incidents per 100 person-years with rivaroxaban versus 0.55 per 100 person-years with warfarin, yielding a hazard rate of 0.88 (95% confidence interval, 0.66-1.17). This association remained consistent across types of venous thromboembolism (deep venous thrombosis vs pulmonary embolism, and provoked vs unprovoked venous thromboembolism) and when censoring patients with recurrent venous thromboembolism. CONCLUSIONS: In this clinical practice setting, rivaroxaban was associated with lower but statistically nonsignificant rates of post-thrombotic syndrome, which did not appear to be mediated only by an effect on recurrent venous thromboembolism.
Authors: Damon E Houghton; Alexander Lekah; Thanila A Macedo; David Hodge; Rayya A Saadiq; Yvonne Little; Ana I Casanegra; Robert D McBane; Waldemar E Wysokinski Journal: J Thromb Thrombolysis Date: 2020-02 Impact factor: 2.300
Authors: Ingrid M Bistervels; Roisin Bavalia; Jan Beyer-Westendorf; Arina J Ten Cate-Hoek; Sebastian M Schellong; Michael J Kovacs; Nicolas Falvo; Karina Meijer; Dominique Stephan; Wim G Boersma; Marije Ten Wolde; Francis Couturaud; Peter Verhamme; Dominique Brisot; Susan R Kahn; Waleed Ghanima; Karine Montaclair; Amanda Hugman; Patrick Carroll; Gilles Pernod; Olivier Sanchez; Emile Ferrari; Pierre-Marie Roy; Marie-Antoinette Sevestre-Pietri; Simone Birocchi; Hilde S Wik; Barbara A Hutten; Michiel Coppens; Christiane Naue; Michael A Grosso; Minggao Shi; Yong Lin; Isabelle Quéré; Saskia Middeldorp Journal: Res Pract Thromb Haemost Date: 2022-07-01