Safety and feasibility of rivaroxaban in deferred workup of patients with suspected deep vein thrombosis
Open Access
- 9 June 2020
- journal article
- research article
- Published by American Society of Hematology in Blood Advances
- Vol. 4 (11), 2468-2476
- https://doi.org/10.1182/bloodadvances.2020001556
Abstract
Guidelines suggest using empiric low-molecular-weight heparin if the diagnostic workup of deep vein thrombosis (DVT) is expected to be delayed. The role of direct oral anticoagulants for deferred compression ultrasound imaging (CUS) in patients with suspected DVT remains unexplored. The main objective of the study was to assess the safety of deferring CUS with therapeutic doses of rivaroxaban. We prospectively included consecutive outpatients referred to the Emergency Department at Ostfold Hospital, Norway, with suspected first or recurrent lower-extremity DVT between February 2015 and November 2018. Patients were discharged with rivaroxaban 15 mg twice daily while awaiting CUS within 24 hours if D-dimer level was >= 0.5 mg/L fibrinogen-equivalent units. The primary outcome was the rate of major bleeding incidents from study inclusion until DVT was confirmed and anticoagulation therapy continued, or otherwise up to 48 hours following administration of the last tablet of rivaroxaban. The secondary outcome was the rate of progressive DVT symptoms or symptoms or signs of pulmonary embolism between hospital discharge until venous thromboembolism was diagnosed. Six hundred twenty-four of 1653 patients referred with suspected DVT were included (37.7%; 95% confidence interval [CI], 35.4-40.1). DVT was diagnosed in 119 patients (19.1%; 95% CI, 16.1-22.3). There were no major bleeding incidents, yielding an observed major bleeding rate of 0% (1-sided 95% CI,0.4). No patients experienced major complications in the interval that CUS was deferred (0%; 95% CI, 0.0-0.6). Deferring CUS for up to 24 hours in patients with suspected DVT with therapeutic doses of rivaroxaban is a safe strategy.This publication has 22 references indexed in Scilit:
- Anticoagulation therapy patterns for acute treatment of venous thromboembolism in GARFIELD‐VTE patientsJournal of Thrombosis and Haemostasis, 2019
- Anticoagulant selection for patients with VTE—Evidence from a systematic literature review of network meta-analysesPharmacological Research, 2019
- Rivaroxaban for non-valvular atrial fibrillation and venous thromboembolism in the Netherlands: a real-world data based cost-effectiveness analysisJournal of Medical Economics, 2019
- Rapid quantitative D‐dimer to exclude pulmonary embolism: a prospective cohort management studyJournal of Thrombosis and Haemostasis, 2016
- Definition of clinically relevant non‐major bleeding in studies of anticoagulants in atrial fibrillation and venous thromboembolic disease in non‐surgical patients: communication from the SSC of the ISTHJournal of Thrombosis and Haemostasis, 2015
- Antithrombotic Therapy for VTE Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice GuidelinesSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2012
- Management of primary care patients with suspected deep vein thrombosis: use of a therapeutic dose of low‐molecular‐weight heparin to avoid urgent ultrasonographic evaluationJournal of Thrombosis and Haemostasis, 2006
- Deferment of Objective Assessment of Deep Vein Thrombosis and Pulmonary Embolism Without Increased Risk of ThrombosisArchives of Internal Medicine, 2004
- The impact of the development of a program to reduce urgent (off-hours) venous duplex ultrasound scan studies.Journal of Vascular Surgery, 2002
- Thrombosis in the Emergency DepartmentArchives of Internal Medicine, 1999