Abstract Number: PB2401
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » VTE Treatment
Background: Apixaban and rivaroxaban, the two most commonly prescribed direct oral anticoagulants (DOACs), were assessed in large clinical trials and approved for acute venous thromboembolism (VTE) therapy without pre-treatment with heparinoids (PrHep). Therefore, it remains unclear whether PrHep can change clinical outcomes related to these anticoagulants.
Aims: Evaluate the effects of PrHep on clinical outcome of patients treated with apixaban or rivaroxaban for VTE.
Methods: Consecutive patients enrolled in the Mayo Clinic VTE Registry between March 2013 and November 2019 with acute VTE were followed prospectively. Patient outcomes were assessed in person, by mailed questionnaire, or scripted phone interview.
Results: Of the 2798 patients enrolled, 1468 were treated with apixaban (n=931) or rivaroxaban (n=584) of which 655 (426 apixaban, 229 rivaroxaban) had PrHep (404 low molecular weight heparin and 251 unfractionated heparin). The mean duration of PrHep was 3.1±3.5 days (median 2.0, range 0.5-14 days). PrHep group had a higher percentage of pulmonary embolism (51.0% vs 30.4%, p< 0.001) and cancer (40.9% vs 31.6%, p=0.001) compared to the no pre-treatment (nPrHep) group. VTE recurrence (rate per 100 person-years) was not different in PrHep versus nPrHep therapies when analyzed in the total patient group (1.72 vs 2.48, p=0.45), apixaban group (1.80 vs 3.45, p=0.28), or rivaroxaban (1.64 vs 1.52, p=0.83) group (Table 1 and Figure 1). Death, major bleeding, and clinically relevant non-major bleeding (CRNMB) were not different in these three groups when PrHep to nPrHep managements were compared (Table 1).
Conclusions: PrHep does not change clinical outcomes of apixaban or rivaroxaban therapy. More patients with pulmonary embolism and with cancer had heparinoid pre-treatment reflecting frequent hospitalization for pulmonary embolus management and only recently changed recommendations for cancer-associated VTE therapy.
| Outcome | Total group, PrHep vs nPrHep (p-value) | Apixaban, PrHep vs nPrHep (p-value) | Rivaroxaban, PrHep vs nPrHep (p-value) |
| VTE recurrence | 1.72 vs 2.48 (0.45) | 1.80 vs 3.45 (0.28) | 1.64 vs 1.52 (0.83) |
| Death | 26.11 vs 22.90 (0.34) | 29.38 vs 25.18 (0.15) | 22.15 vs 20.62 (0.76) |
| Major bleeding | 2.97 vs 3.25 (0.82) | 3.62 vs 3.41 (0.88) | 2.19 vs 3.09 (0.60) |
| CRNMB | 6.71 vs 8.21 (0.38) | 5.42 vs 8.54 (0.23) | 8.30 vs 7.87 (0.97) |
[Table 1. Outcomes in PrHep versus nPrHep in the total patient group and separately for apixaban and rivaroxaban (rates per 100 person-years).]
[Figure 1. Kaplan-Meier curves: VTE recurrence in the total patient, apixaban, & rivaroxaban groups comparing pre-treatment versus no pre-treatment.]
To cite this abstract in AMA style:
Vlazny DT, Casanegra AI, Houghton DE, Froehling DA, Hodge DO, Lang T, Peterson LG, Wysokinski W. Pre-Treatment with Heparinoids Does Not Impact Clinical Outcome of Apixaban and Rivaroxaban in Patients Treated for Venous Thromboembolism [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/pre-treatment-with-heparinoids-does-not-impact-clinical-outcome-of-apixaban-and-rivaroxaban-in-patients-treated-for-venous-thromboembolism/. Accessed September 27, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/pre-treatment-with-heparinoids-does-not-impact-clinical-outcome-of-apixaban-and-rivaroxaban-in-patients-treated-for-venous-thromboembolism/