Treatment with direct oral anticoagulants in patients with upper extremity deep vein thrombosis

Objectives Central-venous devices are risk-factors for upper extremity deep vein thrombosis. We surveyed physicians to identify practice-patterns and adherence to American College of Chest Physicians guidelines. Methods The 13-question survey obtained physician-demographics and treatment-choices. Respondents were grouped into surgical and medical specialists. Data were reported as ratios and percentages, and compared using Fisher’s exact test. Results We received 143 responses from physicians; 65% treated one-to-two new cases/month. Most physicians (69.2%) used anticoagulation; 36.4% retained the catheter and 32.9% removed it. Medical-specialists retained catheters more often than surgeons ( p = 0.027). For recurrences, 84% repeated anticoagulation; 50.3% retained the catheter. A majority anticoagulated upper-extremity deep-vein thrombosis in long-term catheters for three months only (55.1%). Direct oral anticoagulants were used frequently (43.6%). Only 10% believed that existing guidelines were appropriate and only 2.8% followed all guidelines. Conclusion There is great variability in treatment-decisions for upper-extremity deep-vein thrombosis. The existing guidelines are considered inadequate and not followed by most physicians.

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Upper extremity deep vein thrombosis treated with direct oral anticoagulants: a multi-center real world experience

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-020-02044-4 ◽

2020 ◽

Vol 50 (2) ◽

pp. 355-360 ◽

Cited By ~ 1

Author(s):

Angelo Porfidia ◽

Fabiana Agostini ◽

Igor Giarretta ◽

Diego Tonello ◽

Daniele Pastori ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Upper Extremity ◽

Real World ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Vein Thrombosis ◽

Deep Vein

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Policy Change for Deep Vein Thrombosis: Effects on Length of Stay and Hospitalization Costs of Moving From Warfarin to Direct Oral Anticoagulants

Clinical Therapeutics ◽

10.1016/j.clinthera.2018.12.006 ◽

2019 ◽

Vol 41 (2) ◽

pp. 269-279 ◽

Cited By ~ 1

Author(s):

Adam D. Porath ◽

Sharon Clodfelter ◽

Terra Slaton ◽

Brahim K. Bookhart ◽

Chris M. Kozma ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Length Of Stay ◽

Policy Change ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Vein Thrombosis ◽

Hospitalization Costs ◽

Deep Vein

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Upper extremities deep vein thrombosis and DOAC treatment: a prospective cohort study

European Heart Journal ◽

10.1093/ehjci/ehaa946.2407 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M.C Vedovati ◽

G Tratar ◽

A Mavri ◽

L Pierpaoli ◽

G Agnelli ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Pacemaker Implantation ◽

Limb Ischemia ◽

Central Venous Line ◽

Upper Extremities ◽

Acute Limb Ischemia ◽

Vein Thrombosis ◽

Deep Vein

Abstract Background Data on the use of direct oral anticoagulants (DOACs) in patients with upper extremities deep vein thrombosis (UEDVT) are limited. Purpose 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 (VTE). Study outcomes were recurrent VTE and major bleeding (MB) 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 (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 followup in those who continued DOACs was 9.3 months. No recurrence of VTE nor MBs occurred during DOAC treatment; one patient had acute limb ischemia (1.38% patient-year), 7 clinically relevant non-MBs (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. Funding Acknowledgement Type of funding source: None

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Morbidly Obese Patient on Rivaroxaban Presents With Recurrent Upper Extremity Deep Vein Thrombosis: A Case Report

Journal of Pharmacy Practice ◽

10.1177/0897190019851358 ◽

2019 ◽

Vol 33 (5) ◽

pp. 712-719 ◽

Cited By ~ 2

Author(s):

Sin-Ling T. Jennings ◽

Khanh N. P. Manh ◽

Jusilda Bita

Keyword(s):

Deep Vein Thrombosis ◽

Obese Patient ◽

Upper Extremity ◽

Oral Anticoagulants ◽

Morbidly Obese ◽

Vein Thrombosis ◽

Morbidly Obese Patient ◽

The Right ◽

Direct Acting ◽

Deep Vein

A morbidly obese patient with history of deep vein thrombosis and pulmonary embolism was diagnosed with an acute left upper extremity deep vein thrombosis and started on rivaroxaban. Three months later, the patient returned with swelling in the right arm and was found to have a right brachial thrombosis. Anticoagulant therapy was switched to a low-molecular-weight heparin, and patient was discharged on enoxaparin along with an order to follow-up with a hematologist. Subanalyses from randomized controlled trials, pharmacokinetic/pharmacodynamic, and real-world studies suggest that rivaroxaban may be effective and safe in morbidly obese patients for primary and secondary prevention of venous thromboembolism. However, the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis does not recommend the use of direct-acting oral anticoagulants in this population. If used, drug levels should be monitored to guide the therapy. Due to the disparity in data to show efficacy and safety of rivaroxaban in morbidly obese subjects, the interpatient variability of rivaroxaban’s effects in subjects, and the lack of defined therapeutic range for rivaroxaban drug concentration, rivaroxaban should be used cautiously in this population.

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Association between Sarcopenia/Lower Muscle Mass and Short-Term Regression of Deep Vein Thrombosis Using Direct Oral Anticoagulants

International Heart Journal ◽

10.1536/ihj.20-032 ◽

2020 ◽

Vol 61 (4) ◽

pp. 787-794

Author(s):

Yuta Torii ◽

Kenya Kusunose ◽

Robert Zheng ◽

Hirotsugu Yamada ◽

Rie Amano ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Muscle Mass ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Short Term ◽

Vein Thrombosis ◽

Deep Vein

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Treatment Failure of Venous Stenting With or Without Direct Oral Anticoagulants (DOAC) / Non-Vitamin K Oral Anticoagulants (NOACs) in Patients With Deep Vein Thrombosis (DVT) in Term of the Stent Patency: Protocol for a Systematic Review

10.21203/rs.3.rs-1033417/v1 ◽

2021 ◽

Author(s):

Bahram Mohebbi ◽

Jamal Moosavi ◽

Behshid Ghadrdoost ◽

Ayatollah Bayatian ◽

Hooman Bakhshandeh ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Treatment Failure ◽

Vitamin K ◽

Patency Rate ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Stent Patency ◽

Venous Stenting ◽

Vein Thrombosis ◽

Deep Vein

Abstract Background: Venous stenting plays a significant role in the treatment of acute deep vein thrombosis (DVT). But the adjuvant anti-coagulant therapy could also help to more successful patency rate. We hope to elucidate the differences in the patency rate of venous stenting with or without direct oral anticoagulants (DOAC) / non-vitamin K oral anticoagulants (NOACs). Methods: Studies that work on the stent patency rate in venous stent with or without DOAC / NOAC will be included. The primary studies (Cohort, case control, case-series or randomized/ non-randomized trials) will be included if the participants / patients have had acute or chronic DVT, with venous stenting (at least one study group or all of study subjects) who have received DOAC / NOAC agents. The stent patency rate should be reported in all of study subjects within a follow-up time, minimum for 1 year. We will perform an electronic search on published or in press articles, which have been published in MEDLINE / PubMed, Embase, the online Cochrane database, CENTRAL and searches of clinical trial registries: clinicalTrials.gov, EU Clinical Trials, ISRCTN registry, WHO network registry for trials. PROSPERO databases will be manually searched for protocols.After screening of the relevant articles, selection and data extraction will be conducted in duplicate and independently. Methodological quality of the selected studies will be assessed using the Newcastle Ottawa Scale (NOS) tool. We will use “Hazard Ratio” (HR) as the optimum Effect Size (ES) in this meta-analysis, otherwise we will use or calculate “Risk Ratio” (RR) or “Odds Ratio” (OR) ES measures as the selected study specific ES. Discussion: In this review, we hope to find the treatment failure/ success rate of venous stenting with or without DOAC / NOAC regards to the stent patency rate and will try to provide insights into the right choice of anti-coagulant therapy.Submitted to PROSPERO (20/9/2021): CRD42021274542

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