Oral Anticoagulation Treatment and Persistence After Venous Thromboembolism In a Real World Population: The Q-VTE Study Cohort

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2386-2386
Author(s):  
Vicky Tagalakis ◽  
Valerie Patenaude ◽  
Susan R. Kahn ◽  
Samy Suissa
Keyword(s):  
Venous Thromboembolism ◽  
Real World ◽  
Oral Anticoagulation ◽  
Clinical Guidelines ◽  
Conflicts Of Interest ◽  
Vitamin K Antagonists ◽  
Study Cohort ◽  
World Population ◽  
Treatment Persistence ◽  
Number Of Patients

Abstract Background For patients who are diagnosed with venous thromboembolism (VTE) provoked by transient risk factors, clinical guidelines typically recommend 3 months of oral anticoagulation, with longer treatment considered for unprovoked VTE. Describing treatment patterns of VTE in a real world population may identify remedial gaps in patient care. Aim We aimed to characterize oral anticoagulant treatment with vitamin K antagonists (VKA) following incident VTE and assess persistence of VKA therapy in patients with provoked vs. unprovoked VTE in a real world setting. Methods We used the linked administrative healthcare databases of the province of Québec, Canada, including the hospitalization, universal healthcare services, and out-patient prescription databases. We identified all beneficiaries with an incident DVT or PE between 2000 and 2009, which we classified as definite or probable VTE using a priori determined diagnostic algorithms based on ICD-9-CM or ICD-10-CA diagnosis codes. We formed two patient cohorts, one with definite and the other including definite or probable first-time VTE, that were followed until death or end of study (December 31, 2009). Anticoagulant out-patient prescription patterns were analyzed for both patient cohorts. Results From 245,452 Québec residents between 2000 and 2009 with at least 1 VTE diagnosis in RAMQ or MED-ÉCHO, we formed the definite VTE cohort including 40,776 definite cases and the any VTE cohort consisting of 54,803 definite or probable cases. From the 40,776 patients with a first definite VTE, there were 24,860 patients with DVT alone (61%) and 15,916 with PE with or without DVT (39%). Furthermore, there were 78% of patients over the age of 60 and 58.3% of patients were women. In all, 8,998 (22.1%) patients had an unprovoked VTE event while 19,010 (46.6%) patients had a provoked non-cancer event. Similar findings were found in the any VTE cohort. Among definite VTE cohort patients with a provoked non-cancer VTE, 68.6% of patients received anticoagulation after the VTE event. Most were dispensed VKA (64.9%) and 23.9% received a prescription for low molecular weight heparin (LMWH). Among patients with an unprovoked VTE, 86.3% of patients were prescribed anticoagulation (84.5% used VKA and 39.9% used LMWH). Overall, a greater number of patients received anticoagulation following PE (85.2%) than DVT alone (66.2%). Results were similar in the any VTE cohort. Persistence with VKA therapy among patients with provoked VTE was 86.9% at 90 days, 59.5% at 180 days and 19.9% at 365 days. Treatment persistence for patients with unprovoked non-cancer VTE was 88.8%, 66.8% and 22.9% for 90, 180 and 365 days, respectively. Similar findings were found in the any VTE cohort. Conclusions Our study provides useful information on VTE management in a real world population. Treatment persistence was similar for patients with provoked and unprovoked VTE. VKA therapy duration after provoked VTE was longer than the recommended 3 months, whereas treatment was shorter than suggested in patients with unprovoked VTE. Further investigation is needed to determine reasons for non-adherence to clinical guidelines. Disclosures: No relevant conflicts of interest to declare.

Treatment patterns of venous thromboembolism in a real-world population: The Q-VTE study cohort

2014 ◽  
Vol 134 (4) ◽  
pp. 795-802 ◽  
Author(s):  
Vicky Tagalakis ◽  
Valérie Patenaude ◽  
Susan R. Kahn ◽  
Samy Suissa
Keyword(s):  
Venous Thromboembolism ◽  
Real World ◽  
Treatment Patterns ◽  
Study Cohort ◽  
World Population

Incidence of and Mortality from Venous Thromboembolism in a Real-world Population: The Q-VTE Study Cohort

2013 ◽  
Vol 126 (9) ◽  
pp. 832.e13-832.e21 ◽  
Author(s):  
Vicky Tagalakis ◽  
Valérie Patenaude ◽  
Susan R. Kahn ◽  
Samy Suissa
Keyword(s):  
Venous Thromboembolism ◽  
Real World ◽  
Study Cohort ◽  
World Population

scholarly journals Anticoagulation Use prior to Common Dental Procedures: A Systematic Review

2019 ◽  
Vol 2019 ◽  
pp. 1-13 ◽  
Author(s):  
Johnny Chahine ◽  
Marwan N. Khoudary ◽  
Samer Nasr
Keyword(s):  
Systematic Review ◽  
Oral Anticoagulation ◽  
Thromboembolic Event ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Novel Oral Anticoagulants ◽  
Thromboembolic Risk ◽  
Dental Procedures ◽  
Number Of Patients

Currently, the number of patients on oral anticoagulation is increasing. There is a paucity of data regarding maintaining oral anticoagulation (especially novel oral anticoagulants) around the time of specific dental procedures. A dentist has three options: either to stop anticoagulation, to continue it, or to bridge with heparin. A systematic review of 10 clinical trials was conducted to address this issue. It was found that continuing anticoagulation during dental procedures did not increase the risk of bleeding in most trials. Although none of the studies reported a thromboembolic event after interruption of anticoagulation, the follow-up periods were short and inconsistent, and the heightened thromboembolic risk when stopping anticoagulation is well known in the literature. Heparin bridging was associated with an increased bleeding incidence. We recommend maintaining oral anticoagulation with vitamin K antagonists and novel oral anticoagulants for the vast majority of dental procedures along with the use of local hemostatic agents.

288Thrombotic events in bleeding patients treated with andexanet alpha: an ANNEXA-4 sub-study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Beyer-Westendorf ◽  
P Yue ◽  
M Crowther ◽  
J W Eikelboom ◽  
C M Gibson ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Median Time ◽  
Major Bleeding ◽  
Oral Anticoagulation ◽  
Thrombotic Event ◽  
Thrombotic Risk ◽  
Number Of Patients ◽  
Fxa Inhibitor ◽  
Deep Vein ◽  
Deep Vein Thromboses

Abstract Background/Introduction Andexanet alfa (“andexanet”) was developed as a specific reversal agent for patients with major bleeding while using factor Xa (FXa) inhibitors. While thrombotic events (TEs) have been reported in patients receiving andexanet, the scope, nature, and timing of these events have not been fully characterized. Purpose The ANNEXA-4 study was a prospective, single-arm, open-label clinical trial that evaluated the safety and efficacy of andexanet in patients with acute major bleeding. In this secondary analysis, the occurrence of TEs was investigated. Methods Patients presenting with acute major bleeding within 18 hours after their last dose of FXa inhibitor were treated with andexanet. Safety outcomes, including TEs (reviewed by an adjudication committee), were evaluated at 30 days. Results Among 352 patients treated with andexanet, 34 (9.7%) experienced one or more TEs (Table). Strokes and deep vein thromboses were the most frequent TE types. Compared to patients with arterial TEs, patients with venous TEs were more likely to have been originally anticoagulated for venous thromboembolism. Median time to first TE was 10.5 days (Figure); time to event was shorter for arterial TEs than for venous TEs. TEs were nonfatal for most patients. Subgroups by age, bleed type, baseline anti-fXa activity, FXa inhibitor dose, and andexanet dose were not associated with the occurrence of TEs. Of the 34 TE patients, 26 (76.4%) had TEs before restart of any (full or prophylactic) anticoagulation; all first TEs occurred in patients not receiving oral anticoagulation. No TEs occurred after resumption of oral anticoagulation (N=100). Table 1. Thrombotic event characteristics Characteristic Result (n/N [%]) TE type   Strokes 14/352 (4.0%)   Deep vein thromboses 13/352 (3.7%)   Myocardial infarctions 7/352 (2.0%)   Pulmonary embolisms 5/352 (1.4%)   Transient ischemic attacks 1/352 (0.3%) Bleed type   Intracranial 23/227 (10.1%)   Gastrointestinal 7/90 (7.8%)   Other 4/35 (11.4%) Arterial TEs   Anticoagulated for AF 17/22 (77.3%)   Anticoagulated for VTE 6/22 (27.3%) Venous TEs   Anticoagulated for AF 11/18 (61.1%)   Anticoagulated for VTE 8/18 (44.4%)   Median time to first TE 10.5 days   Arterial 6 days   Venous 15 days Outcome   Fatal 7/34 (20.6%)   Nonfatal 27/34 (79.4%) AF = atrial fibrillation; n = number of patients with TEs; N = total number of patients for each characteristic; TE = thrombotic event; VTE = venous thromboembolism. Figure 1. Thrombotic Events Over Time Conclusions In patients with FXa inhibitor-associated acute major bleeding treated with andexanet, TEs occurred a rate not unexpected given the high thrombotic risk of the population. No factors predictive of TEs were identified. Resumption of anticoagulation was associated with fewer TEs. Acknowledgement/Funding Study funded by Portola Pharmaceuticals, Inc.

scholarly journals Quality of oral anticoagulation with vitamin K antagonists in ‘real-world’ patients with atrial fibrillation: a report from the prospective multicentre FANTASIIA registry

EP Europace ◽  
2017 ◽  
Vol 20 (9) ◽  
pp. 1435-1441 ◽  
Author(s):  
María Asunción Esteve-Pastor ◽  
José Miguel Rivera-Caravaca ◽  
Inmaculada Roldán-Rabadán ◽  
Vanessa Roldán ◽  
Javier Muñiz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Real World ◽  
Oral Anticoagulation ◽  
Vitamin K Antagonists

scholarly journals Patient Knowledge about Oral Anticoagulation Therapy Assessed during an Intermediate Medication Review in Swiss Community Pharmacies

Pharmacy ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 54
Author(s):  
Corina Metaxas ◽  
Valerie Albert ◽  
Susanne Habegger ◽  
Markus Messerli ◽  
Kurt E. Hersberger ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Vitamin K ◽  
Oral Anticoagulation ◽  
Medication Review ◽  
Vitamin K Antagonists ◽  
Anticoagulation Therapy ◽  
Community Pharmacies ◽  
Patient Knowledge ◽  
Knowledge Gaps ◽  
Number Of Patients

Background: Therapy with oral anticoagulation (OAC) can be challenging, especially in high risk groups such as chronic patients. Gaps in patient knowledge about OAC are linked to reduced effectiveness and safety of treatment. The objectives of this study were i) to assess OAC knowledge gathered during an intermediate medication review (MR) in patients taking vitamin K antagonists (VKA) or non-vitamin K antagonist oral anticoagulants (NOAC); ii) to assess OAC knowledge two weeks after the MR, and iii) to evaluate patient satisfaction with the MR service in community pharmacies. Methods: Chronic OAC patients were invited for a regular MR service in Swiss community pharmacies, the so-called “Polymedication-Check” (PMC). OAC knowledge was assessed with seven newly generated items asked face-to-face during a PMC and by telephone two weeks later. Knowledge gaps, pharmacists’ spontaneous interventions, and patient satisfaction were documented by observing pharmacy students. Treatment groups were compared. Results: Of all patients (n = 81), the number of patients with one or more knowledge gaps decreased from 66% to 31.3% after PMC (p < 0.001). NOAC patients (n = 31) had more knowledge gaps than VKA patients (n = 50; p < 0.05). Most patients (98.6%) were satisfied with the counselling provided by the pharmacists. Conclusion: The majority of chronic OAC patients shows knowledge gaps. Although spontaneous, the provision of tailored education during a PMC increased patient OAC knowledge.

Real-world safety of pemetrexed, carboplatin, and pembrolizumab in U.S. NSCLC patients.

2020 ◽  
Vol 38 (5_suppl) ◽  
pp. 50-50
Author(s):  
Catherine Muehlenbein ◽  
Sangmi Kim ◽  
Ekaterina Ryabko ◽  
Ana Oton ◽  
Himani Agg ◽  
...  
Keyword(s):  
Real World ◽  
Safety Data ◽  
Treatment Phase ◽  
Occurrence Rate ◽  
World Population ◽  
Induction Phase ◽  
Mild Renal Impairment ◽  
Number Of Patients ◽  
Grade 3 ◽  
Nsclc Patients

50 Background: A Phase 3 KEYNOTE-189 clinical trial showed improved clinical benefit with acceptable toxicity of pemetrexed combined with pembrolizumab and platinum (Gandhi, 2018). However, the safety data with this combination has not been evaluated in a real-world setting with large number of patients with non-squamous non-small cell lung cancer (NSQ NSCLC). Methods: Flatiron Health’s electronic health record-derived data were used to identify advanced NSQ NSCLC patients (≥18 y) who received pemetrexed, pembrolizumab, and carboplatin (≤6 cycles; Pem+Pembro+Carb) as initial treatment from May 2017 to Oct 2018. Endpoints were overall occurrence of select laboratory adverse events (AEs; any Grade and Grade ≥3), which were described by treatment phase (Pem/Pembro cycles < 5 vs ≥5) and pre-specified subgroups. Results: The study included 1088 patients (median age = 68 y; male, 57%). In patients with maintenance (Pem/Pembro ≥5) cohort (N = 462), the median number of treatment cycles was 9 for Pembro and 6 for Pem. The occurrence rates of neutrophil count decrease and platelet count decrease were numerically higher in the induction phase, whereas those of chronic kidney disease (CKD) showed an opposite trend (Table). Grade ≥3 CKD occurrence rate was higher in patients with mild renal impairment (5.1% vs 2.6%) and elderly (≥75 y) patients (7.5% vs 3.3%). Conclusions: Considering the heterogeneity and vulnerability of real-world population, the laboratory AE occurrence rate with Pem+Pembro+Carb in this study was comparable with those reported in KEYNOTE-189. Various trends were observed for the respective AEs by treatment phase. [Table: see text]

scholarly journals O32 Serious infection with tocilizumab compared to TNF-inhibitors and other bDMARDS in rheumatoid arthritis patients: does line of therapy matter?

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Kim Lauper ◽  
Lianne Kearsley-Fleet ◽  
Rebecca Davies ◽  
Kath Watson ◽  
Mark Lunt ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Real World ◽  
Disease Duration ◽  
Tnf Inhibitors ◽  
World Population ◽  
Research Support ◽  
Serious Infection ◽  
Number Of Patients ◽  
Serious Infections ◽  
Line Of Therapy

Abstract Background/Aims  In the real-world, tocilizumab is prescribed to a population of patients different from those prescribed TNF-inhibitors, often older with longer disease duration, worse functional status and more previous b- or tsDMARDs. The aim of this study was to evaluate if and how the risk of serious infection on tocilizumab and other bDMARDs differs when stratifying by line of therapy in a real-world population of rheumatoid arthritis patients. Methods  We included patients registered in the BSRBR-RA treated with tocilizumab, etanercept, adalimumab, infliximab, certolizumab, abatacept or rituximab, including biosimilars. Primary outcome was the occurrence of a serious infection (defined as infection requiring hospitalisation, intravenous antibiotics or resulting in death). Primary covariate of interest was line of therapy (from first to fifth line of therapy). Every change to another b- or tsDMARD was considered a new line of therapy, but not a change between a bio-original and a biosimilar. Hazard ratios (HR) of serious infections were estimated using an inverse probability weighted Cox regression, based on a propensity score including baseline patient and disease characteristics, and adjusting for time in study (see table). The reference group was etanercept, which included the highest number of patients. Treatment exposure was analysed without and with stratification by line of therapy. Results  A total of 33,916 treatment courses were included (Table) contributing to 62,532 years of follow-up. Compared to etanercept, participants starting abatacept, tocilizumab and rituximab were older, had more previous bDMARDs, longer disease duration and more comorbidities. The crude HR of serious infections were higher with infliximab and adalimumab, lower with certolizumab and rituximab, and not significantly different for abatacept and tocilizumab compared to etanercept. After adjustment, HR of serious infections were higher with tocilizumab, adalimumab and infliximab. However, when stratified by line of therapy, HR were no longer significantly different compared to etanercept for tocilizumab, adalimumab and infliximab for most lines of therapy. Conclusion  Whilst initially there appears to be a difference in rates of serious infections between biologic therapies, line of therapy may be a confounding factor when comparing the risk of serious infections between bDMARDs. Disclosure  K. Lauper: Honoraria; Gilead-Galapagos. Grants/research support; AbbVie. Other; AbbVie, Pfizer. L. Kearsley-Fleet: None. R. Davies: None. K. Watson: None. M. Lunt: None. K.L. Hyrich: Honoraria; AbbVie. Grants/research support; Pfizer, BMS.

Risk of arterial and venous thromboembolic events among patients with colorectal carcinoma: a real-world, population-based study

2021 ◽  
Author(s):  
Omar Abdel-Rahman ◽  
Cynthia Wu ◽  
Jacob Easaw
Keyword(s):  
Colorectal Cancer ◽  
Venous Thromboembolism ◽  
Colorectal Carcinoma ◽  
Metastatic Disease ◽  
Real World ◽  
Thromboembolic Event ◽  
World Population ◽  
Thromboembolic Events ◽  
Factors Associated ◽  
Male Sex

Objective: To assess real-world patterns of arterial and venous thromboembolism among patients with colorectal carcinoma. Methods: The Alberta provincial cancer registry and other provincial medical records were used to identify patients with colorectal cancer (2004–2018) with no preceding or succeeding cancer diagnosis. The incidence of both arterial and venous thromboembolism in this patient population as well as factors associated with these thromboembolic events were examined through logistic regression analysis. Results: A total of 17,296 patients were found eligible and were included into the current study. We observed that 1564 patients (9%) experienced a thromboembolic event and 15,732 patients (91%) did not. The following factors were associated with any thromboembolic event: male sex (odds ratio [OR]: 1.20; 95% CI: 1.08–1.34), higher comorbidity (OR: 1.36; 95% CI: 1.31–1.41), metastatic disease (OR for nonmetastatic vs metastatic disease: 0.53; 95% CI: 0.47–0.60), living within North zone (OR for Edmonton zone vs North zone: 0.70; 95% CI: 0.59–0.84), treatment with fluoropyrimidines (OR for no fluoropyrimidines vs fluoropyrimidines: 0.53; 95% CI: 0.47–0.60) and treatment with bevacizumab (OR: for no bevacizumab vs bevacizumab: 0.53; 95% CI: 0.47–0.60). Factors associated with venous thromboembolism include, younger age (continuous OR with increasing age: 0.99; 95% CI: 0.98–0.99), higher comorbidity (OR: 1.10; 95% CI: 1.04–1.17), metastatic disease (OR for nonmetastatic disease vs metastatic disease: 0.40; 95% CI: 0.35–0.47), North zone (OR for Edmonton zone vs North zone: 0.70; 95% CI: 0.56–0.86), treatment with fluoropyrimidines (OR for no fluoropyrimidines vs fluoropyrimidines: 0.45; 95% CI: 0.39–0.53) and treatment with bevacizumab (OR for no bevacizumab vs bevacizumab: 0.73; 95% CI: 0.58–0.93). Conclusion: Thromboembolic events are not uncommon among colorectal cancer patients, and the risk is increased with male sex, higher comorbidity, presence of metastatic disease, living within the North zone of the province (where there is limited access to tertiary care centers) and treatment with fluoropyrimidines or bevacizumab.

Epidemiology of non-vitamin K antagonist oral anticoagulants in heart disease

ESC CardioMed ◽  
2018 ◽  
pp. 244-248
Author(s):  
Renate Schnabel ◽  
Dipak Kotecha ◽  
Paulus Kirchhof
Keyword(s):  
Atrial Fibrillation ◽  
Venous Thromboembolism ◽  
Vitamin K ◽  
Oral Anticoagulation ◽  
Heart Valves ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
European Population ◽  
Transcatheter Valve ◽  
Pathway Inhibition

Atrial fibrillation and venous thromboembolism are the most common conditions requiring oral anticoagulation. Atrial fibrillation affects approximately 2% of the European population. Age, increasing common risk factors for atrial fibrillation, and earlier detection of atrial fibrillation will increase atrial fibrillation prevalence in the near future. Venous thromboembolism incidence ranges between 1 and 1.8 per 1000 person-years and is associated with substantial mortality. Oral anticoagulation with vitamin K antagonists and non-vitamin K oral anticoagulants (NOACs) has recently increased, and can help to prolong lives and enhance quality of years lived. Further, NOACs have become part of dual-pathway inhibition in patients with atherosclerotic disease, in particular after acute coronary syndrome and percutaneous coronary interventions. Whereas NOACs are not advised for anticoagulation in patients with mechanical heart valves, they are increasingly prescribed after transcatheter valve therapy.

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