J Clin Pharmacol. 2023 Sep 23. doi: 10.1002/jcph.2350. Online ahead of print.
ABSTRACT
Various lead-in dosing strategies have been used in clinical practice for venous thromboembolism (VTE), and guidelines do not currently address if the full lead-in dosing duration is necessary after receiving parenteral anticoagulation. This study aims to identify if full lead-in dosing duration surrounding parenteral anticoagulation affects thrombotic and bleeding outcomes. A single-center, retrospective cohort study was conducted of hospitalized patients diagnosed with VTE and treated with apixaban or rivaroxaban. Patients were grouped depending on duration of lead-in dosing, with the full lead-in dosing group considered as the appropriate duration of the DOAC. The primary outcome was the recurrence of VTE within the index admission to six months. Secondary outcomes included major bleeding, clinically-relevant minor bleeding, and mortality. Ninety-three patients were prescribed full lead-in dosing, while 99 patients received reduced lead-in dosing. The primary outcome of recurrent VTE was similar between the reduced lead-in group compared to the full lead-in group (3% vs 2%; p = 1.0). Major bleeding within the index admission was significantly higher in the reduced lead-in group: 11 vs. 2 (p = 0.02). There were no significant differences in other secondary outcomes. Full lead-in dosing compared to reduced lead-in dosing duration for VTE had similar rates of thrombotic and mortality events. The higher rate of major bleeding in the reduced-lead in dosing group likely reflects the prescribing practices in less stable patients. This study provides evidence to support reduced lead-in dosing duration in high-risk patients without compromising efficacy outcomes. This article is protected by copyright. All rights reserved.
PMID:37740594 | DOI:10.1002/jcph.2350