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. 2018 Dec;24(9_suppl):209S-216S.
doi: 10.1177/1076029618804080. Epub 2018 Oct 2.

Venous Thromboembolism: A Survey of Oral Anticoagulant Preferences in the Treatment of Challenging Patient Populations

Genevieve Claire Moyer  1   2 , Bethany Samuelson Bannow  3   4 , Courtney Thornburg  5   6 , Rachel Rosovsky  7 , Tzu-Fei Wang  8 , Scott Woller  9   10 , Dianne Thornhill  2 , Lisa Baumann Kreuziger  11   12
Affiliations

Venous Thromboembolism: A Survey of Oral Anticoagulant Preferences in the Treatment of Challenging Patient Populations

Genevieve Claire Moyer et al. Clin Appl Thromb Hemost. 2018 Dec.

Abstract

Venous thromboembolism (VTE) is a highly morbid condition with several available oral anticoagulant treatment options. Numerous studies have been published comparing warfarin to direct oral anticoagulants; however, several populations remain underrepresented in these reports. We surveyed members of The Venous ThromboEmbolism Network U.S. working group regarding their oral anticoagulant preferences for the treatment of VTE in different and challenging populations. In individuals with VTE and no other medical comorbidities, respondents preferred either rivaroxaban (48.7%) or apixaban (48.7%). Apixaban (53.3%) was preferred in elderly individuals with an increased risk of bleeding. Warfarin was preferred in individuals with liver or kidney dysfunction (42% and 47%), altered metabolism (>55%), and antiphospholipid antibody syndrome (84.2%). Low-molecular-weight heparin was preferred in individuals with malignancy (56.6%), followed by edoxaban (23.7%). These findings may help guide clinicians when choosing an anticoagulant in these challenging situations and demonstrate the urgent need for additional study in these groups.

Keywords: anticoagulants; deep vein thrombosis; factor Xa inhibitors; low-molecular-weight heparins; lupus inhibitor; venous thromboembolism.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Woller served as a panelist for the American College of Chest Physicians (ACCP) Antithrombotic Guideline, 10th Edition. Tzu-Fei Wang, MD, is a site investigator for a phase 3 trial of rivaroxaban in children sponsored by Bayer. Rachel Rosovsky, MD MPH has been involved clinical trial research for both Bristol-Myers Squibb and Janssen pharmaceuticals. She also serves on the advisory board for Portola and is a consultant for BMS.

Figures

Figure 1.
Figure 1.
Survey responses for individuals with venous thromboembolism (VTE) and no other medical comorbidities.
Figure 2.
Figure 2.
Survey responses for individuals with organ dysfunction and venous thromboembolism (VTE) .
Figure 3.
Figure 3.
Survey responses for individuals with perceived increased bleeding risk and venous thromboembolism (VTE) .
Figure 4.
Figure 4.
Survey responses for individuals with altered metabolism and venous thromboembolism (VTE) .
Figure 5.
Figure 5.
Survey responses for individuals with antiphospholipid syndrome (APS) or active malignancy and venous thromboembolism (VTE).
See this image and copyright information in PMC

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