Abstract Number: PB2435
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » VTE Treatment
Background: Limited data are available on the use of direct oral anticoagulants (DOACs) in patients with upper extremities deep vein thrombosis (UEDVT).
Aims: To assess the effectiveness and safety of DOACs in the treatment of UEDVT.
Methods: Data on patients with an objective diagnosis of acute UEDVT treated with DOACs were merged from prospective cohorts of patients with venous thromboembolism to obtain a collaborative database. Study outcomes were recurrent venous thromboembolism (VTE) and major bleeding occurring during DOAC treatment.
Results: Overall, 132 patients were included: mean age was 47.7±18.0 years (range 18 to 97), males were 42.4%. Twenty-seven percent of patients had 2 or more risk factors for VTE, 29.5% had UEDVT complicating a central venous line or after pacemaker implantation (see Table).
Ninety-two patients (70%) were managed as outpatients. Increased age (OR 1.03, 95% CI 1.0-1.05) and anemia (OR 1.35, 95% CI 1.07-1.70) were associated with in-patient management. Among patients treated with apixaban (40) or rivaroxaban (85) loading dose was used in 72%; in patients treated with dabigatran (5) or edoxaban (2) mean heparin pre-treatment was 8 days. DOACs were started after 1 month from UEDVT diagnosis in 12.9% of patients; active cancer was a main predictor for delayed initiation (OR 22.2, 95% CI 5.8-84.4).
Mean treatment duration in patients with a scheduled stop was 4.9 months, while mean follow-up in those who continued DOACs was 9.3 months.
No recurrence of VTE nor major bleedings occurred during DOAC treatment; one patient had acute limb ischemia (1.38% patient-year), 7 clinically relevant non-major bleedings (3 genital, 2 epistaxis, 1 gingival, 1 genital bleeding plus epistaxis; 10.51% patient-year), 5 deaths (4 cancer, 1 advanced age; 9.69% patient-year).
Conclusions: Our data support the effectiveness and safety of DOACs for the treatment of acute UEDVT. Further studies are required to confirm these findings.
Overall (n= 132) | Active cancer (n= 34) | Non-cancer risk factor (n= 62) | Unprovoked (n= 36) | |
Age, years mean±SD | 47.7±18.0 | 55.4±13.2 | 46.1±18.1 | 43.3±19.9 |
Male, n (%) | 56 (42.4) | 14 (41.2) | 23 (37.1) | 19 (52.8) |
Concomitant pulmonary embolism, n (%) | 11 (8.3) | 3 (8.8) | 5 (8.1) | 3 (8.3) |
Weight, kg mean±SD | 71.6±14.9 | 67.3±10.5 | 74.8±16.0 | 69.6±15.6 |
CVC, PICC or PMK, n (%) | 39 (29.5) | 19 (55.9) | 20 (32.3) | – |
Recent surgery or trauma, n (%) | 19 (14.4) | 2 (5.9) | 17 (27.4) | – |
Effort thrombosis or thoracic outlet syndrome, n (%) | 12 (9.1) | 0 | 12 (19.4) | – |
Thrombophilia or estrogen-progestin therapy, n (%) | 17 (12.9) | 1 (2.9) | 16 (25.8) | – |
Patients with a scheduled stop treatment, n (%) | 79 (59.8) | 10 (29.4) | 44 (70.9) | 25 (69.4) |
[Characteristics and risk factors of patients with UEDVT treated with DOACs]
To cite this abstract in AMA style:
Vedovati MC, Tratar G, Mavri A, Pierpaoli L, Agnelli G, Becattini C. Upper Extremities Deep Vein Thrombosis and DOAC Treatment: a Prospective Cohort Study [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/upper-extremities-deep-vein-thrombosis-and-doac-treatment-a-prospective-cohort-study/. Accessed March 21, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/upper-extremities-deep-vein-thrombosis-and-doac-treatment-a-prospective-cohort-study/