Abstract Number: PB2479
Meeting: ISTH 2020 Congress
Background: DOACs are effective in preventing and treating VTE. However, in clinical practice, treatment failure occurs (recurrent VTE, post-thrombotic syndrome during and after anticoagulation). If patients are adequately anticoagulated, the occurrence of thromboembolism (whether primary or recurrent) constitutes anticoagulation failure.
Aims: We defined the failure of DOAC treatment in adequately anticoagulated patients. We identified etiological factors, the cause of VTE recurrence during and after the treatment with DOAC
Methods: We present a group of 15 adequately anticoagulated patients with recurrent VTE despite anticoagulation (USG) and the post-thrombotic syndromes. All participants were assessed for the presence of the inherited thrombophilia including factor V Leiden, prothrombin mutation, MTHFR mutation, PAI-1 mutation, protein S and C deficiency, antithrombin deficiency and presence of the thyroid autoimunity, celiac disease, cardiovascular disease, inflammatory bowel disease, cancer , antiphospholipid antibody.
Results: 10 patients experienced recurrence of VTE (USG verified) during the treatment DOAC. Five patients developed the post-thrombotic syndrome and recurrent VTE 4 to 8 weeks after the discontinuation of DOAC. We assume that the treatment failure was caused by clinical condition, clinical risk factors but not by DOAC.
Conclusions: The optimal management of complications in patients with DOAC treatment failure is unclear and the options include the following: 1. Dose escalation, 2. Switching over to an alternative anticoagulant, 3. Adding an antiplatelet agent. In clinical practice, it is important to decide whether treatment failure is due to drug (DOAC) or underlying disease. It is important to correctly diagnose recurrence of VTE, to distinguish recurrence from the residual thrombosis, and to correctly interpret the laboratory test results
To cite this abstract in AMA style:Hulikova M, Hulikova J. DOACs in Real Clinical Practice [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/doacs-in-real-clinical-practice/. Accessed January 23, 2022.
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