Contributions
Abstract: S309
Type: Oral Presentation
Session title: Malignancies and thrombosis
Background
Large randomized controlled trials that compared direct oral anticoagulants (DOACs) to vitamin K antagonists (VKA), for the treatment of venous thromboembolism (VTE), demonstrated both efficacy and safety of DOACs.
Aims
The aim of the current study was to compare DOACs to low molecular weight heparin (LMWH)/VKA in terms of efficacy and safety, for the treatment of VTE in the elderly, in a real-life setting
Methods
Retrospective cohort study performed in Rabin Medical Center encompassing a 7 –year period. We included all hospitalized patients > 65 years old, with a diagnosis of lower extremity deep vein thrombosis (DVT) and/or pulmonary emboli (PE) discharged with DOACs or LMWH/VKA. The primary outcome was a composite of all-cause mortality, major bleeding events, recurrent VTEs and hospitalizations throughout the follow up period of one year. Secondary outcomes included recurrent VTEs, major bleeding events and all-cause mortality in one year. Overall survival was assessed by the Kaplan Meier model, with the log-rank test. The Cox Proportional Hazards model was used to calculate hazard ratios (HR). Medication was included in the Cox model as a time dependent covariate. Propensity score matching was used to create a matched cohort
Results
Overall, 603 patients were identified and included in the final analysis. A total of 476 patients were treated with VKA/LMWH and 127 patients were treated with DOACs. The mean age was 79.9 ± 8.5 years )VKA/LMWH group( and 78.6 ± 8.1 years )DOAC group(, P=0.24. The primary unadjusted composite outcome of all-cause mortality, major bleeding events, recurrent VTEs and hospitalizations occurred in 355/ 476 patients (74.6%) in the VKA/LMWH group and in 72/ 127 (56.7%) patients in the DOACs group, hazard ratio (HR) of 0.59, 95% confidence interval (CI) 0.46 to 0.76,,in favor of the DOAC group. HR for recurrent VTEs and major bleedings events was 0.58 (95% CI 0.26 to 1.29) and 1.15 (95% CI 0.50 to 2.65), respectively for the DOAC group. There was a significant reduction in mortality in the DOAC group - HR 0.30, 95% CI 0.20 to 0.44. In a multivariable analysis, treatment with DOACs, as well as age, elevated creatinine levels and malignancy were all significantly associated with the composite outcome of all-cause mortality, major bleeding, recurrent VTE and hospitalizations, HR of 0.64 (CI of 0.49-0.83) for the treatment with DOAC. In a matched cohort analysis, the results were the same as the original analysis, with a HR of 0.66 for the DOAC group for the composite outcome, 95% CI 0.51 to 0.87
Conclusion
In the elderly population, treatment of VTE with DOACs was associated with a lower rate of the composite outcome of all-cause mortality, major bleeding, recurrent VTE and hospitalizations in a follow up of one year. DOACs are safe and effective for elderly patients with VTE
Keyword(s): Coumadin, Elderly, Oral anticoagulant, Venous thromboembolism
Abstract: S309
Type: Oral Presentation
Session title: Malignancies and thrombosis
Background
Large randomized controlled trials that compared direct oral anticoagulants (DOACs) to vitamin K antagonists (VKA), for the treatment of venous thromboembolism (VTE), demonstrated both efficacy and safety of DOACs.
Aims
The aim of the current study was to compare DOACs to low molecular weight heparin (LMWH)/VKA in terms of efficacy and safety, for the treatment of VTE in the elderly, in a real-life setting
Methods
Retrospective cohort study performed in Rabin Medical Center encompassing a 7 –year period. We included all hospitalized patients > 65 years old, with a diagnosis of lower extremity deep vein thrombosis (DVT) and/or pulmonary emboli (PE) discharged with DOACs or LMWH/VKA. The primary outcome was a composite of all-cause mortality, major bleeding events, recurrent VTEs and hospitalizations throughout the follow up period of one year. Secondary outcomes included recurrent VTEs, major bleeding events and all-cause mortality in one year. Overall survival was assessed by the Kaplan Meier model, with the log-rank test. The Cox Proportional Hazards model was used to calculate hazard ratios (HR). Medication was included in the Cox model as a time dependent covariate. Propensity score matching was used to create a matched cohort
Results
Overall, 603 patients were identified and included in the final analysis. A total of 476 patients were treated with VKA/LMWH and 127 patients were treated with DOACs. The mean age was 79.9 ± 8.5 years )VKA/LMWH group( and 78.6 ± 8.1 years )DOAC group(, P=0.24. The primary unadjusted composite outcome of all-cause mortality, major bleeding events, recurrent VTEs and hospitalizations occurred in 355/ 476 patients (74.6%) in the VKA/LMWH group and in 72/ 127 (56.7%) patients in the DOACs group, hazard ratio (HR) of 0.59, 95% confidence interval (CI) 0.46 to 0.76,,in favor of the DOAC group. HR for recurrent VTEs and major bleedings events was 0.58 (95% CI 0.26 to 1.29) and 1.15 (95% CI 0.50 to 2.65), respectively for the DOAC group. There was a significant reduction in mortality in the DOAC group - HR 0.30, 95% CI 0.20 to 0.44. In a multivariable analysis, treatment with DOACs, as well as age, elevated creatinine levels and malignancy were all significantly associated with the composite outcome of all-cause mortality, major bleeding, recurrent VTE and hospitalizations, HR of 0.64 (CI of 0.49-0.83) for the treatment with DOAC. In a matched cohort analysis, the results were the same as the original analysis, with a HR of 0.66 for the DOAC group for the composite outcome, 95% CI 0.51 to 0.87
Conclusion
In the elderly population, treatment of VTE with DOACs was associated with a lower rate of the composite outcome of all-cause mortality, major bleeding, recurrent VTE and hospitalizations in a follow up of one year. DOACs are safe and effective for elderly patients with VTE
Keyword(s): Coumadin, Elderly, Oral anticoagulant, Venous thromboembolism