Early prescription of direct oral anticoagulant for the treatment of intermediate-high risk pulmonary embolism: a multi-center, observational cohort study

2020 ◽  
Vol 196 ◽  
pp. 476-482
Author(s):  
Romain Chopard ◽  
Marc Badoz ◽  
Charly Eveno ◽  
Fiona Ecarnot ◽  
Nicolas Falvo ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cohort Study ◽  
High Risk ◽  
Oral Anticoagulant ◽  
Observational Cohort Study ◽  
Direct Oral Anticoagulant ◽  
Observational Cohort

scholarly journals The daily practice of direct oral anticoagulant use in patients with atrial fibrillation; an observational cohort study

PLoS ONE ◽  
2019 ◽  
Vol 14 (6) ◽  
pp. e0217302 ◽  
Author(s):  
Anouk J. W. Gulpen ◽  
Hugo ten Cate ◽  
Yvonne M. C. Henskens ◽  
René van Oerle ◽  
Rick Wetzels ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Oral Anticoagulant ◽  
Daily Practice ◽  
Observational Cohort Study ◽  
Direct Oral Anticoagulant ◽  
Observational Cohort

scholarly journals Length of Stay Comparison between Rivaroxaban and Warfarin in the Treatment of Pulmonary Embolism: Results from a Real-World Observational Cohort Study

Thrombosis ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Kirsten M. Roberts ◽  
Tamara B. Knight ◽  
Eimeira Padilla-Tolentino ◽  
Manasa Murthy ◽  
Evan J. Peterson
Keyword(s):  
Pulmonary Embolism ◽  
Cohort Study ◽  
Length Of Stay ◽  
Oral Anticoagulant ◽  
Oral Anticoagulants ◽  
Observational Cohort Study ◽  
Time Interval ◽  
Secondary Endpoints ◽  
Observational Cohort ◽  
Post Hoc

Background. Trials have shown that novel oral anticoagulants may decrease length of stay versus warfarin. A comparison of length of stay in the treatment of pulmonary embolism (PE) has not been performed outside post hoc analysis of a large clinical trial. Objective. To evaluate if rivaroxaban decreases length of stay compared to warfarin plus enoxaparin in the treatment of PE. Methods. This was a multicenter, retrospective, observational cohort study. Patients were identified based on discharge diagnosis of PE and were excluded if they received anticoagulants prior to admission and had additional indications for anticoagulation or reduced creatinine clearance. The primary endpoint was length of stay. Secondary endpoints included time from initial dose of oral anticoagulant to discharge and length of stay comparison between subgroups. Results. Inclusion criterion was met by 158 patients (82 warfarin, 76 rivaroxaban). The median length of stay was 4.5 days (interquartile range [IQR], 2.7, 5.9) in the warfarin group and 1.8 days (IQR, 1.2, 3.7) in the rivaroxaban group (P<0.001). Time interval from first dose of oral anticoagulant to discharge was shorter with rivaroxaban (P<0.001). Conclusions. Patients given rivaroxaban had decreased length of stay versus those given warfarin plus enoxaparin for the treatment of PE.

scholarly journals Evaluation of the incidence of bleeding in patients prescribed rivaroxaban for the treatment and prevention of deep vein thrombosis and pulmonary embolism in UK secondary care: an observational cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038102
Author(s):  
Alison Evans ◽  
Miranda Davies ◽  
Vicki Osborne ◽  
Debabrata Roy ◽  
Saad Shakir
Keyword(s):  
Pulmonary Embolism ◽  
Cohort Study ◽  
Deep Vein Thrombosis ◽  
Major Bleeding ◽  
Secondary Care ◽  
Observational Cohort Study ◽  
Vein Thrombosis ◽  
Prevention And Treatment ◽  
Observational Cohort ◽  
Deep Vein

ObjectivesTo evaluate the short-term (12 weeks) safety and utilisation of rivaroxaban prescribed to new-user adult patients for the treatment of deep vein thrombosis and pulmonary embolism and for the prevention of recurrent deep vein thrombosis and pulmonary embolism in a secondary care setting in England and Wales.DesignAn observational cohort study using the technique of Specialist Cohort Event Monitoring.SettingThe Rivaroxaban Observational Safety Evaluation study was conducted across 87 participating National Health Service secondary care trusts in England and Wales.Participants1532 patients treated with rivaroxaban for the prevention and treatment of deep vein thrombosis/pulmonary embolism from September 2013 to January 2016.InterventionsNon-interventional postauthorisation safety study of rivaroxaban.Primary and secondary outcome measures(1) Risk of major bleeding in gastrointestinal, intracranial, and urogenital sites and (2) risk of all major and clinically relevant non-major bleeds.ResultsOf a total of 4846 patients enrolled in the study from September 2013 to January 2016, 1532 were treated with rivaroxaban for the prevention and treatment of deep vein thrombosis/pulmonary embolism. The median age of the deep vein thrombosis/pulmonary embolism cohort was 63 years, and 54.6% were men. The risk of major bleeding within the gastrointestinal, urogenital and intracranial primary sites was 0.7% (n=11), 0.3% (n=5) and 0.1% (n=1), respectively. The risk of major bleeding in all sites was 1.5% (n=23) at a rate of 8.3 events per 100 patient-years.ConclusionsIn terms of the primary outcome risk of major bleeding in gastrointestinal, intracranial and urogenital sites, the risk estimates in the population using rivaroxaban for deep vein thrombosis/pulmonary embolism were low (<1%) and consistent with the risk estimated from clinical trial data and in routine clinical practice.Trial registration numbersClinicalTrials.gov Registry (NCT01871194); ENCePP Registry (EUPAS3979).

scholarly journals Association of placental pathology and postpartum cardiovascular risk screening following preeclampsia: an observational cohort study

2021 ◽  
Author(s):  
Samantha Benton ◽  
Erika Mery ◽  
David Grynspan ◽  
Laura Gaudet ◽  
Graeme Smith ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Risk Score ◽  
Observational Cohort Study ◽  
Cvd Risk ◽  
Risk Screening ◽  
Cardiovascular Screening ◽  
Increased Risk ◽  
Observational Cohort

Objective: To determine the association between placental lesions and lifetime cardiovascular disease (CVD) risk screening at 6 months postpartum following preeclampsia (PE). Design: Observational cohort study. Setting: Tertiary care centres in Ottawa and Kingston, Ontario, Canada. Population: Women diagnosed with PE who received cardiovascular screening at 6 months postpartum. Methods: Placentas from women diagnosed with PE were evaluated for histopathological lesions according to a standardised synoptic data collection form with blinding to clinical outcomes apart from gestational age at delivery. At 6 months postpartum, each participant was screened for cardiovascular risk factors and a lifetime cardiovascular risk score was calculated. A risk score >35% was deemed high risk for lifetime CVD. Main Outcome Measures: The association between placental lesions and lifetime CVD risk was assessed using odds ratios (OR, 95% confidence intervals). Results: Of the 85 participants, 53 (62.4%) screened high-risk for lifetime CVD. High-risk women had more severe lesions of maternal vascular malperfusion (MVM). MVM lesions with a severity score >2 resulted in a 3-fold increased risk of screening high risk for lifetime CVD (OR 3.10 [1.20-7.92]). MVM lesion score >2 was moderately predictive of high-risk screening (AUC 0.63 [0.51,0.75]; sensitivity: 71.8% [54.6,84.4]; specificity: 54.7% [41.5,67.3]). When clinical data was added, the model’s predictive performance improved (AUC 0.73 [0.62,0.84] sensitivity 78.4% [65.4,87.5]; specificity 51.6% [34.8,68.0]). Conclusions: PE women with MVM are more likely to screen high-risk for lifetime CVD compared to women without these lesions. Placenta pathology may provide a unique modality to identify women for postpartum cardiovascular screening.

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