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

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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ORAL ANTICOAGULANTS IN THE TREATMENT OF VENOUS THROMBOEMBOLIC COMPLICATIONS: FOCUS ON APIXABAN

Medical Council ◽

10.21518/2079-701x-2017-7-56-62 ◽

2017 ◽

pp. 56-62 ◽

Cited By ~ 1

Author(s):

M. Yu. Gilyarov ◽

E. V. Konstantinova

Keyword(s):

Vitamin K ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Factor Xa ◽

Vitamin K Antagonist ◽

Fixed Dose ◽

Vein Thrombosis ◽

Venous Thromboembolic ◽

Deep Vein

Venous thromboembolism (VTE), comprising deep vein thrombosis and pulmonary embolism, is a common condition associated with a significant clinical and economic burden. Anticoagulant therapy is the mainstay of treatment for VTE. Current guidelines recommend the use of either low molecular weight heparins or fondaparinux overlapping with and followed by a vitamin K antagonist for the initial treatment of VTE, with the vitamin K antagonist continued when long-term anticoagulation is required. These traditional anticoagulants have practical limitations that have led to the development of direct oral anticoagulants that directly target either Factor Xa or thrombin and are administered at a fixed dose without the need for routine coagulation monitoring. The paper reviews results of the trials of apixaban application for treatment and/or long-term secondary prevention of VTE. The paper analyses effectiveness and safety of apixaban in different groups of patients, as well as features of apixaban application in every day practice.

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Variability in the management of line-related upper extremity deep vein thrombosis

Phlebology The Journal of Venous Disease ◽

10.1177/0268355519827155 ◽

2019 ◽

Vol 34 (8) ◽

pp. 552-558 ◽

Cited By ~ 1

Author(s):

Rafael Cires-Drouet ◽

Jashank Sharma ◽

Tara McDonald ◽

John D Sorkin ◽

Brajesh K Lal

Keyword(s):

Deep Vein Thrombosis ◽

Upper Extremity ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Exact Test ◽

Medical Specialists ◽

Vein Thrombosis ◽

Deep Vein ◽

Question Survey

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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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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