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P5585Determinants of the use of direct oral anticoagulants in acute pulmonary thromboembolism in argentina
Abstract Background In the last decade, direct oral anticoagulants (DOACs) were incorporated as an alternative for anticoagulation in patients with venous thromboembolism. Although they have a better pharmacologic profile than vitamin K antagonists (VKAs), the use of these drugs is not massive. Purp...
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| Published in: | European heart journal 2019-10, Vol.40 (Supplement_1) |
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| creator | Bernal, M I Scatularo, C E Cigalini, I M Jauregui, J C C Ortego, J I Cornejo, D Aboy, J M Burgos, L M Gamarra, A L Visconti, M Garcia Zamora, S Igolnikof, D B Bonorino, J M Zaidel, E J Thierer, J |
| description | Abstract
Background
In the last decade, direct oral anticoagulants (DOACs) were incorporated as an alternative for anticoagulation in patients with venous thromboembolism. Although they have a better pharmacologic profile than vitamin K antagonists (VKAs), the use of these drugs is not massive.
Purpose
Assess the rate of use of DOACs in acute pulmonary embolism (PE) patients (P) in Argentina and analyze the determinants of their use.
Methods
Based on a registry of 684 P admitted for acute PE in 75 academic centers between October 2016 and November 2017, we performed an analysis of DOACs prescription at discharge. A conventional statistical analysis was performed, to assess the differences between the P that received DOACs or other anticoagulants using univariate and multivariate models.
Results
579 of 601 P who survived were discharged with anticoagulant treatment: 348 (60%) received VKA; 108 (19%) received DOACs (49% Rivaroxaban, 34% Apixaban, 17% Dabigatran) and 123 (21%) received low molecular weight heparins.
Patients who received DOACs had lower severity of PE and less risk of bleeding. The main baseline characteristics are described in table 1. Also, those patients who received DOACs at discharge had fewer in-hospital complications (heart failure, infections or bleeding; all p |
| doi_str_mv | 10.1093/eurheartj/ehz746.0529 |
| format | article |
| fullrecord | <record><control><sourceid>oup_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1093_eurheartj_ehz746_0529</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/eurheartj/ehz746.0529</oup_id><sourcerecordid>10.1093/eurheartj/ehz746.0529</sourcerecordid><originalsourceid>FETCH-LOGICAL-c879-de85cbcf86ef060186d083026c739d5615396c262f824aa5f4e23410d9089dc73</originalsourceid><addsrcrecordid>eNqNkM9qwzAMh83YYF23Rxj4BdLKTuzax9H9hcJ26GG34Dpyk5DExU4O29PPbcfOOwgJ9PuE-Ai5Z7BgoPMlTqFGE8Z2ifX3qpALEFxfkBkTnGdaFuKSzIBpkUmpPq_JTYwtACjJ5Iy0H0Io8Ygjhr4ZzDBG6h0da6RTxONYNQHtSH0wHU3rxnqzn7pTsBmosdOI9DB1vR9M-Epg8P3OY6quif0pEvaYuMHckitnuoh3v31Ots9P2_Vrtnl_eVs_bDKrVjqrUAm7s05JdCCBKVmByoFLu8p1JSQTuZaWS-4UL4wRrkCeFwwqDUpXKTQn4nzWBh9jQFceQtOn50oG5dFX-eerPPsqj74SB2fOT4d_Ij8NbXSC</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>P5585Determinants of the use of direct oral anticoagulants in acute pulmonary thromboembolism in argentina</title><source>Oxford Journals - Connect here FIRST to enable access</source><creator>Bernal, M I ; Scatularo, C E ; Cigalini, I M ; Jauregui, J C C ; Ortego, J I ; Cornejo, D ; Aboy, J M ; Burgos, L M ; Gamarra, A L ; Visconti, M ; Garcia Zamora, S ; Igolnikof, D B ; Bonorino, J M ; Zaidel, E J ; Thierer, J</creator><creatorcontrib>Bernal, M I ; Scatularo, C E ; Cigalini, I M ; Jauregui, J C C ; Ortego, J I ; Cornejo, D ; Aboy, J M ; Burgos, L M ; Gamarra, A L ; Visconti, M ; Garcia Zamora, S ; Igolnikof, D B ; Bonorino, J M ; Zaidel, E J ; Thierer, J</creatorcontrib><description>Abstract
Background
In the last decade, direct oral anticoagulants (DOACs) were incorporated as an alternative for anticoagulation in patients with venous thromboembolism. Although they have a better pharmacologic profile than vitamin K antagonists (VKAs), the use of these drugs is not massive.
Purpose
Assess the rate of use of DOACs in acute pulmonary embolism (PE) patients (P) in Argentina and analyze the determinants of their use.
Methods
Based on a registry of 684 P admitted for acute PE in 75 academic centers between October 2016 and November 2017, we performed an analysis of DOACs prescription at discharge. A conventional statistical analysis was performed, to assess the differences between the P that received DOACs or other anticoagulants using univariate and multivariate models.
Results
579 of 601 P who survived were discharged with anticoagulant treatment: 348 (60%) received VKA; 108 (19%) received DOACs (49% Rivaroxaban, 34% Apixaban, 17% Dabigatran) and 123 (21%) received low molecular weight heparins.
Patients who received DOACs had lower severity of PE and less risk of bleeding. The main baseline characteristics are described in table 1. Also, those patients who received DOACs at discharge had fewer in-hospital complications (heart failure, infections or bleeding; all p<0.05).
In the multivariate analysis, health insurance (OR 7.45, 95% CI: 1.74–31.9, p<0.01) was an independent predictor of DOACs prescription at discharge. The history of previous heart failure (OR 0.19, 95% CI: 0.04–0.84, p=0.03) or oncologic disease (OR 0.49; 95% CI: 0.27–0.89; p=0.02) were inversely and independent predictors for DOACs prescription.
Variable
DOACs
Other anticoagulants
P
OR
CI (95%)
Male sex
51 (47.2%)
196 (41.6%)
0.29
–
–
Age
64.3±17.6
63.3±16.6
0.61
–
–
Health insurance
106 (98.1%)
402 (85.4%)
0.01
9.1
(2.2–37.7)
CKD without dialysis
2 (1.9%)
34 (7.3%)
0.06
0.24
(0.06–1.03)
Heart failure
2 (1.9%)
55 (11.7%)
0.01
0.14
(0.03–0.59)
Oncology disease
16 (14.8%)
127 (27%)
0.01
0.47
(0.27–0.83)
Previous anticoagulation
3 (2.8%)
44 (9.3%)
0.03
0.28
(0.08–0.91)
sPESI
1±1.12
1.28±1.11
0.02
0.78
(0.64–0.96)
RIETE
1.71±1.17
2.05±1.33
0.02
0.81
(0.68–0.97)
CKD: Chronic kidney disease; TIA: Transient ischemic attack.
Conclusions
The rate of use of DOACs in survivors of an acute PE in Argentina was 19%, and this P present lower clinical risk, fewer co-morbidities and greater access to health coverage.</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehz746.0529</identifier><language>eng</language><publisher>Oxford University Press</publisher><ispartof>European heart journal, 2019-10, Vol.40 (Supplement_1)</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com. 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,1591,27957,27958</link.rule.ids></links><search><creatorcontrib>Bernal, M I</creatorcontrib><creatorcontrib>Scatularo, C E</creatorcontrib><creatorcontrib>Cigalini, I M</creatorcontrib><creatorcontrib>Jauregui, J C C</creatorcontrib><creatorcontrib>Ortego, J I</creatorcontrib><creatorcontrib>Cornejo, D</creatorcontrib><creatorcontrib>Aboy, J M</creatorcontrib><creatorcontrib>Burgos, L M</creatorcontrib><creatorcontrib>Gamarra, A L</creatorcontrib><creatorcontrib>Visconti, M</creatorcontrib><creatorcontrib>Garcia Zamora, S</creatorcontrib><creatorcontrib>Igolnikof, D B</creatorcontrib><creatorcontrib>Bonorino, J M</creatorcontrib><creatorcontrib>Zaidel, E J</creatorcontrib><creatorcontrib>Thierer, J</creatorcontrib><title>P5585Determinants of the use of direct oral anticoagulants in acute pulmonary thromboembolism in argentina</title><title>European heart journal</title><description>Abstract
Background
In the last decade, direct oral anticoagulants (DOACs) were incorporated as an alternative for anticoagulation in patients with venous thromboembolism. Although they have a better pharmacologic profile than vitamin K antagonists (VKAs), the use of these drugs is not massive.
Purpose
Assess the rate of use of DOACs in acute pulmonary embolism (PE) patients (P) in Argentina and analyze the determinants of their use.
Methods
Based on a registry of 684 P admitted for acute PE in 75 academic centers between October 2016 and November 2017, we performed an analysis of DOACs prescription at discharge. A conventional statistical analysis was performed, to assess the differences between the P that received DOACs or other anticoagulants using univariate and multivariate models.
Results
579 of 601 P who survived were discharged with anticoagulant treatment: 348 (60%) received VKA; 108 (19%) received DOACs (49% Rivaroxaban, 34% Apixaban, 17% Dabigatran) and 123 (21%) received low molecular weight heparins.
Patients who received DOACs had lower severity of PE and less risk of bleeding. The main baseline characteristics are described in table 1. Also, those patients who received DOACs at discharge had fewer in-hospital complications (heart failure, infections or bleeding; all p<0.05).
In the multivariate analysis, health insurance (OR 7.45, 95% CI: 1.74–31.9, p<0.01) was an independent predictor of DOACs prescription at discharge. The history of previous heart failure (OR 0.19, 95% CI: 0.04–0.84, p=0.03) or oncologic disease (OR 0.49; 95% CI: 0.27–0.89; p=0.02) were inversely and independent predictors for DOACs prescription.
Variable
DOACs
Other anticoagulants
P
OR
CI (95%)
Male sex
51 (47.2%)
196 (41.6%)
0.29
–
–
Age
64.3±17.6
63.3±16.6
0.61
–
–
Health insurance
106 (98.1%)
402 (85.4%)
0.01
9.1
(2.2–37.7)
CKD without dialysis
2 (1.9%)
34 (7.3%)
0.06
0.24
(0.06–1.03)
Heart failure
2 (1.9%)
55 (11.7%)
0.01
0.14
(0.03–0.59)
Oncology disease
16 (14.8%)
127 (27%)
0.01
0.47
(0.27–0.83)
Previous anticoagulation
3 (2.8%)
44 (9.3%)
0.03
0.28
(0.08–0.91)
sPESI
1±1.12
1.28±1.11
0.02
0.78
(0.64–0.96)
RIETE
1.71±1.17
2.05±1.33
0.02
0.81
(0.68–0.97)
CKD: Chronic kidney disease; TIA: Transient ischemic attack.
Conclusions
The rate of use of DOACs in survivors of an acute PE in Argentina was 19%, and this P present lower clinical risk, fewer co-morbidities and greater access to health coverage.</description><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNqNkM9qwzAMh83YYF23Rxj4BdLKTuzax9H9hcJ26GG34Dpyk5DExU4O29PPbcfOOwgJ9PuE-Ai5Z7BgoPMlTqFGE8Z2ifX3qpALEFxfkBkTnGdaFuKSzIBpkUmpPq_JTYwtACjJ5Iy0H0Io8Ygjhr4ZzDBG6h0da6RTxONYNQHtSH0wHU3rxnqzn7pTsBmosdOI9DB1vR9M-Epg8P3OY6quif0pEvaYuMHckitnuoh3v31Ots9P2_Vrtnl_eVs_bDKrVjqrUAm7s05JdCCBKVmByoFLu8p1JSQTuZaWS-4UL4wRrkCeFwwqDUpXKTQn4nzWBh9jQFceQtOn50oG5dFX-eerPPsqj74SB2fOT4d_Ij8NbXSC</recordid><startdate>20191001</startdate><enddate>20191001</enddate><creator>Bernal, M I</creator><creator>Scatularo, C E</creator><creator>Cigalini, I M</creator><creator>Jauregui, J C C</creator><creator>Ortego, J I</creator><creator>Cornejo, D</creator><creator>Aboy, J M</creator><creator>Burgos, L M</creator><creator>Gamarra, A L</creator><creator>Visconti, M</creator><creator>Garcia Zamora, S</creator><creator>Igolnikof, D B</creator><creator>Bonorino, J M</creator><creator>Zaidel, E J</creator><creator>Thierer, J</creator><general>Oxford University Press</general><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20191001</creationdate><title>P5585Determinants of the use of direct oral anticoagulants in acute pulmonary thromboembolism in argentina</title><author>Bernal, M I ; Scatularo, C E ; Cigalini, I M ; Jauregui, J C C ; Ortego, J I ; Cornejo, D ; Aboy, J M ; Burgos, L M ; Gamarra, A L ; Visconti, M ; Garcia Zamora, S ; Igolnikof, D B ; Bonorino, J M ; Zaidel, E J ; Thierer, J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c879-de85cbcf86ef060186d083026c739d5615396c262f824aa5f4e23410d9089dc73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bernal, M I</creatorcontrib><creatorcontrib>Scatularo, C E</creatorcontrib><creatorcontrib>Cigalini, I M</creatorcontrib><creatorcontrib>Jauregui, J C C</creatorcontrib><creatorcontrib>Ortego, J I</creatorcontrib><creatorcontrib>Cornejo, D</creatorcontrib><creatorcontrib>Aboy, J M</creatorcontrib><creatorcontrib>Burgos, L M</creatorcontrib><creatorcontrib>Gamarra, A L</creatorcontrib><creatorcontrib>Visconti, M</creatorcontrib><creatorcontrib>Garcia Zamora, S</creatorcontrib><creatorcontrib>Igolnikof, D B</creatorcontrib><creatorcontrib>Bonorino, J M</creatorcontrib><creatorcontrib>Zaidel, E J</creatorcontrib><creatorcontrib>Thierer, J</creatorcontrib><collection>CrossRef</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bernal, M I</au><au>Scatularo, C E</au><au>Cigalini, I M</au><au>Jauregui, J C C</au><au>Ortego, J I</au><au>Cornejo, D</au><au>Aboy, J M</au><au>Burgos, L M</au><au>Gamarra, A L</au><au>Visconti, M</au><au>Garcia Zamora, S</au><au>Igolnikof, D B</au><au>Bonorino, J M</au><au>Zaidel, E J</au><au>Thierer, J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>P5585Determinants of the use of direct oral anticoagulants in acute pulmonary thromboembolism in argentina</atitle><jtitle>European heart journal</jtitle><date>2019-10-01</date><risdate>2019</risdate><volume>40</volume><issue>Supplement_1</issue><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Abstract
Background
In the last decade, direct oral anticoagulants (DOACs) were incorporated as an alternative for anticoagulation in patients with venous thromboembolism. Although they have a better pharmacologic profile than vitamin K antagonists (VKAs), the use of these drugs is not massive.
Purpose
Assess the rate of use of DOACs in acute pulmonary embolism (PE) patients (P) in Argentina and analyze the determinants of their use.
Methods
Based on a registry of 684 P admitted for acute PE in 75 academic centers between October 2016 and November 2017, we performed an analysis of DOACs prescription at discharge. A conventional statistical analysis was performed, to assess the differences between the P that received DOACs or other anticoagulants using univariate and multivariate models.
Results
579 of 601 P who survived were discharged with anticoagulant treatment: 348 (60%) received VKA; 108 (19%) received DOACs (49% Rivaroxaban, 34% Apixaban, 17% Dabigatran) and 123 (21%) received low molecular weight heparins.
Patients who received DOACs had lower severity of PE and less risk of bleeding. The main baseline characteristics are described in table 1. Also, those patients who received DOACs at discharge had fewer in-hospital complications (heart failure, infections or bleeding; all p<0.05).
In the multivariate analysis, health insurance (OR 7.45, 95% CI: 1.74–31.9, p<0.01) was an independent predictor of DOACs prescription at discharge. The history of previous heart failure (OR 0.19, 95% CI: 0.04–0.84, p=0.03) or oncologic disease (OR 0.49; 95% CI: 0.27–0.89; p=0.02) were inversely and independent predictors for DOACs prescription.
Variable
DOACs
Other anticoagulants
P
OR
CI (95%)
Male sex
51 (47.2%)
196 (41.6%)
0.29
–
–
Age
64.3±17.6
63.3±16.6
0.61
–
–
Health insurance
106 (98.1%)
402 (85.4%)
0.01
9.1
(2.2–37.7)
CKD without dialysis
2 (1.9%)
34 (7.3%)
0.06
0.24
(0.06–1.03)
Heart failure
2 (1.9%)
55 (11.7%)
0.01
0.14
(0.03–0.59)
Oncology disease
16 (14.8%)
127 (27%)
0.01
0.47
(0.27–0.83)
Previous anticoagulation
3 (2.8%)
44 (9.3%)
0.03
0.28
(0.08–0.91)
sPESI
1±1.12
1.28±1.11
0.02
0.78
(0.64–0.96)
RIETE
1.71±1.17
2.05±1.33
0.02
0.81
(0.68–0.97)
CKD: Chronic kidney disease; TIA: Transient ischemic attack.
Conclusions
The rate of use of DOACs in survivors of an acute PE in Argentina was 19%, and this P present lower clinical risk, fewer co-morbidities and greater access to health coverage.</abstract><pub>Oxford University Press</pub><doi>10.1093/eurheartj/ehz746.0529</doi></addata></record> |
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| title | P5585Determinants of the use of direct oral anticoagulants in acute pulmonary thromboembolism in argentina |
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