1. Effectiveness and Safety of Early Versus Routine Switching from Low-Molecular-Weight Heparin to Maintenance Therapy of Rivaroxaban for Acute Iliofemoral Vein Thrombosis: A Retrospective Cohort Study.
- Author
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Hou W, Fang D, Yin S, Deng Y, Zhang J, Wang S, Liu L, Kong J, Huang M, Zhang X, Dai B, and Feng X
- Subjects
- Humans, Retrospective Studies, Male, Female, Middle Aged, Treatment Outcome, Time Factors, Aged, Risk Factors, Adult, Acute Disease, Length of Stay, Recurrence, Anticoagulants adverse effects, Anticoagulants administration & dosage, Rivaroxaban adverse effects, Rivaroxaban administration & dosage, Venous Thrombosis drug therapy, Venous Thrombosis diagnostic imaging, Venous Thrombosis mortality, Venous Thrombosis diagnosis, Femoral Vein, Factor Xa Inhibitors adverse effects, Factor Xa Inhibitors administration & dosage, Hemorrhage chemically induced, Drug Administration Schedule, Iliac Vein diagnostic imaging, Drug Substitution, Heparin, Low-Molecular-Weight adverse effects, Heparin, Low-Molecular-Weight administration & dosage
- Abstract
Background: The anticoagulation strategy of switching to rivaroxaban after 1 week of initial low-molecular-weight heparin (LMWH) therapy is recommended by a guideline for the treatment of acute iliofemoral deep vein thrombosis (DVT). However, the initial rivaroxaban dose in the switching strategy, as well as the effectiveness and safety of the early switching (less than 1 week) to rivaroxaban, remain inadequately substantiated. We aimed to evaluate the effectiveness and safety of early switching from LMWH to maintenance therapy of rivaroxaban (20 mg once daily) for acute iliofemoral DVT., Methods: A retrospective cohort study was conducted using data from patients with acute iliofemoral DVT who received initial LMWH anticoagulation followed by rivaroxaban maintenance therapy. The clinical outcomes were compared between early (LMWH course ≤7 days) and routine (LMWH course >7 days) switching strategies within 3 months of initiating anticoagulation., Results: 217 patients were included, 59 (27.2%) receiving early switching and 158 (72.8%) receiving routine switching. Compared with routine switching, patients with early switching had a significantly shorter hospital stay (7 days vs. 14 days, P < 0.001). The length of hospital stay was significantly positively correlated with the duration of LMWH (r = 0.762, P < 0.001). The incidences of recurrent venous thromboembolism (5.1% vs. 2.5%, P = 0.606), major bleeding (0% vs. 1.9%, P = 0.564), clinically relevant nonmajor bleeding (1.7% vs. 2.5%, P = 1.000) and all-cause mortality (6.8% vs. 2.5%, P = 0.283) were not statistically different between the 2 groups., Conclusions: Direct early switching from LMWH to maintenance therapy of rivaroxaban is effective and safe for acute iliofemoral DVT., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
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