Maurizio Margaglione1, Emilia Antonucci2, Giovanna D'Andrea1, Ludovica Migliaccio2, Walter Ageno3, Eugenio Bucherini4, Benilde Cosmi5, Anna Falanga6, Giuliana Martini7, Daniela Mastroiacovo8, Carmelo Paparo9, Daniela Poli10, Sophie Testa11, Gualtiero Palareti2. 1. Medical Genetics, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy. 2. "Arianna Anticoagulazione" Foundation, Bologna, Italy. 3. Department of Medicine and Surgery, University of Insubria, Varese, Italy. 4. Department of Vascular Medicine, AUSL Romagna, Faenza, Italy. 5. Angiology Unit, "Sant'Orsola Malpighi" University Hospital, Bologna, Italy. 6. Thrombosis and Haemostasis Centre, Department of Immunohaematology and Transfusion Medicine, Bergamo, Italy. 7. Department of Laboratory, Brescia Hospital, Brescia, Italy. 8. Department of Angiology, "SS. Filippo e Nicola" Hospital, Avezzano, Italy. 9. Thrombosis Centre, "Maggiore" Hospital, Chieri, Italy. 10. Centre for Atherothrombotic Diseases, "Careggi" University Hospital, Florence, Italy. 11. Haemostasis and Thrombosis Centre, Hospital of Cremona, Cremona, Italy.
Abstract
BACKGROUND: Randomised control trials have assessed the efficacy and safety of direct oral anticoagulants in the prophylaxis and treatment of venous thromboembolism (VTE). Positive but limited results have been reported in patients with inherited thrombophilia. Using an Italian, multicentre, prospective registry of consecutive patients presenting with symptomatic, acute VTE, we aimed to assess which factors are involved in making the choice of the drug that best fits the patient's risk profile in a large real-world setting of VTE patients. MATERIALS AND METHODS: We investigated 4,866 VTE patients who took oral anticoagulants in the period between 2012 and April 2018 to prevent a new thromboembolic episode. RESULTS: The large majority of patients who underwent thrombophilic screening, regardless of the results obtained, were prescribed direct oral anticoagulants rather than conventional anticoagulant therapy (p<0.001). During anticoagulation, bleeding events occurred more frequently in patients on conventional anticoagulant therapy (4.2%) than in those receiving direct oral anticoagulants (1.8%) and an increase in bleeding events was observed in patients who tested positive at the thrombophilic screening. Overall, a higher number of recurrent VTE was observed in patients not screened for thrombophilia (n=36; 1.7%) than in those screened (n=20; 0.7%; adjusted odds ratio: 2.2; 95% confidence interval: 1.2-4.1). DISCUSSION: The present data confirm previous findings from other post-marketing registries and suggest that the choice of oral anticoagulation is strongly driven by patients' characteristics and VTE manifestations. Factors leading to the prescription of thrombophilic screening may identify a patient with a lower risk of VTE recurrence during anticoagulation.
BACKGROUND: Randomised control trials have assessed the efficacy and safety of direct oral anticoagulants in the prophylaxis and treatment of venous thromboembolism (VTE). Positive but limited results have been reported in patients with inherited thrombophilia. Using an Italian, multicentre, prospective registry of consecutive patients presenting with symptomatic, acute VTE, we aimed to assess which factors are involved in making the choice of the drug that best fits the patient's risk profile in a large real-world setting of VTEpatients. MATERIALS AND METHODS: We investigated 4,866 VTEpatients who took oral anticoagulants in the period between 2012 and April 2018 to prevent a new thromboembolic episode. RESULTS: The large majority of patients who underwent thrombophilic screening, regardless of the results obtained, were prescribed direct oral anticoagulants rather than conventional anticoagulant therapy (p<0.001). During anticoagulation, bleeding events occurred more frequently in patients on conventional anticoagulant therapy (4.2%) than in those receiving direct oral anticoagulants (1.8%) and an increase in bleeding events was observed in patients who tested positive at the thrombophilic screening. Overall, a higher number of recurrent VTE was observed in patients not screened for thrombophilia (n=36; 1.7%) than in those screened (n=20; 0.7%; adjusted odds ratio: 2.2; 95% confidence interval: 1.2-4.1). DISCUSSION: The present data confirm previous findings from other post-marketing registries and suggest that the choice of oral anticoagulation is strongly driven by patients' characteristics and VTE manifestations. Factors leading to the prescription of thrombophilic screening may identify a patient with a lower risk of VTE recurrence during anticoagulation.
Authors: Harry R Büller; Hervé Décousus; Michael A Grosso; Michele Mercuri; Saskia Middeldorp; Martin H Prins; Gary E Raskob; Sebastian M Schellong; Lee Schwocho; Annelise Segers; Minggao Shi; Peter Verhamme; Phil Wells Journal: N Engl J Med Date: 2013-08-31 Impact factor: 91.245
Authors: Lisa K Hicks; Harriet Bering; Kenneth R Carson; Judith Kleinerman; Vishal Kukreti; Alice Ma; Brigitta U Mueller; Sarah H O'Brien; Marcelo Pasquini; Ravindra Sarode; Lawrence Solberg; Adam E Haynes; Mark A Crowther Journal: Blood Date: 2013-12-04 Impact factor: 22.113
Authors: Trevor Baglin; Elaine Gray; Mike Greaves; Beverley J Hunt; David Keeling; Sam Machin; Ian Mackie; Mike Makris; Tim Nokes; David Perry; R C Tait; Isobel Walker; Henry Watson Journal: Br J Haematol Date: 2010-01-28 Impact factor: 6.998
Authors: Gregory Y H Lip; Allison Keshishian; Shital Kamble; Xianying Pan; Jack Mardekian; Ruslan Horblyuk; Melissa Hamilton Journal: Thromb Haemost Date: 2016-08-19 Impact factor: 5.249
Authors: Reinhold Kreutz; Lorenzo G Mantovani; Sylvia Haas; Danja Monje; Jonas Schneider; Jörg-Peter Bugge; Martin Gebel; Miriam Tamm; Walter Ageno; Alexander G G Turpie Journal: Thromb Res Date: 2019-02-13 Impact factor: 3.944
Authors: Gregory Y H Lip; Amitava Banerjee; Giuseppe Boriani; Chern En Chiang; Ramiz Fargo; Ben Freedman; Deirdre A Lane; Christian T Ruff; Mintu Turakhia; David Werring; Sheena Patel; Lisa Moores Journal: Chest Date: 2018-08-22 Impact factor: 9.410
Authors: Sam Schulman; Clive Kearon; Ajay K Kakkar; Patrick Mismetti; Sebastian Schellong; Henry Eriksson; David Baanstra; Janet Schnee; Samuel Z Goldhaber Journal: N Engl J Med Date: 2009-12-10 Impact factor: 91.245
Authors: Giuseppe Camporese; Enrico Bernardi; Cristiano Bortoluzzi; Franco Noventa; Ngoc Vo Hong; Elena Callegari; Sabina Villalta; Chiara Tonello; Michela Nardin; Elena Campello; Luca Spiezia; Paolo Simioni Journal: Front Med (Lausanne) Date: 2021-01-28