Safety and feasibility of rivaroxaban in deferred workup of patients with suspected deep vein thrombosis

被引:12
作者
Fronas, Synne G. [1 ,2 ]
Dahm, Anders E. A. [2 ,3 ]
Wik, Hilde S. [4 ]
Jorgensen, Camilla T. [1 ]
Gleditsch, Jostein [5 ]
Raouf, Nezar [1 ]
Holst, Rene [1 ,6 ,7 ]
Klok, Frederikus A. [8 ]
Ghanima, Waleed [1 ,9 ]
机构
[1] Ostfold Hosp Trust, Dept Emergency Med, Clin Internal Med, Gralum, Norway
[2] Univ Oslo, Inst Clin Med, Oslo, Norway
[3] Akershus Univ Hosp, Dept Hematol, Lorenskog, Norway
[4] Oslo Univ Hosp, Dept Hematol, Oslo, Norway
[5] Ostfold Hosp Trust, Dept Radiol, Gralum, Norway
[6] Univ Oslo, Oslo Ctr Biostat & Epidemiol, Oslo, Norway
[7] Oslo Univ Hosp, Oslo, Norway
[8] Leiden Univ, Dept Thrombosis & Hemostasis, Med Ctr, Leiden, Netherlands
[9] Univ Oslo, Inst Clin Med, Dept Hematol, Oslo, Norway
关键词
PULMONARY-EMBOLISM; D-DIMER; DEFINITION; DIAGNOSIS; DISEASE; IMPACT; MODEL;
D O I
10.1182/bloodadvances.2020001556
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:2468 / 2476
页数:9
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