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Intracranial Hemorrhage in Deep Vein Thrombosis/Pulmonary Embolus Patients Without Atrial Fibrillation : Direct Oral Anticoagulants Versus Warfarin: Direct Oral Anticoagulants Vers...
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| Zeitschriftentitel: | Stroke |
|---|---|
| Personen und Körperschaften: | , , , , , , |
| In: | Stroke, 49, 2018, 8, S. 1866-1871 |
| Format: | E-Article |
| Sprache: | Englisch |
| veröffentlicht: |
Ovid Technologies (Wolters Kluwer Health)
|
| Schlagwörter: |
| author_facet |
Lamsam, Layton Sussman, Eric S. Iyer, Aditya K. Bhambhvani, Hriday P. Han, Summer S. Skirboll, Stephen Ratliff, John K. Lamsam, Layton Sussman, Eric S. Iyer, Aditya K. Bhambhvani, Hriday P. Han, Summer S. Skirboll, Stephen Ratliff, John K. |
|---|---|
| author |
Lamsam, Layton Sussman, Eric S. Iyer, Aditya K. Bhambhvani, Hriday P. Han, Summer S. Skirboll, Stephen Ratliff, John K. |
| spellingShingle |
Lamsam, Layton Sussman, Eric S. Iyer, Aditya K. Bhambhvani, Hriday P. Han, Summer S. Skirboll, Stephen Ratliff, John K. Stroke Intracranial Hemorrhage in Deep Vein Thrombosis/Pulmonary Embolus Patients Without Atrial Fibrillation : Direct Oral Anticoagulants Versus Warfarin Advanced and Specialized Nursing Cardiology and Cardiovascular Medicine Neurology (clinical) |
| author_sort |
lamsam, layton |
| spelling |
Lamsam, Layton Sussman, Eric S. Iyer, Aditya K. Bhambhvani, Hriday P. Han, Summer S. Skirboll, Stephen Ratliff, John K. 0039-2499 1524-4628 Ovid Technologies (Wolters Kluwer Health) Advanced and Specialized Nursing Cardiology and Cardiovascular Medicine Neurology (clinical) http://dx.doi.org/10.1161/strokeaha.118.022156 <jats:sec> <jats:title>Background and Purpose—</jats:title> <jats:p>Deep vein thrombosis (DVTs) is a common disease with high morbidity if it progresses to pulmonary embolus (PE). Anticoagulation is the treatment of choice; warfarin has long been the standard of care. Early experience with direct oral anticoagulants (DOACs) suggests that these agents may be may be a safer and equally effective alternative in the treatment of DVT/PE. Nontraumatic intracranial hemorrhage (ICH) is one of the most devastating potential complications of anticoagulation therapy. We sought to compare the rates of ICH in patients treated with DOACs versus those treated with warfarin for DVT/PE.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods—</jats:title> <jats:p>The MarketScan Commercial Claims and Medicare Supplemental databases were used. Adult DVT/PE patients without known atrial fibrillation and with prescriptions for either a DOAC or warfarin were followed for the occurrence of inpatient admission for ICH. Coarsened exact matching was used to balance the treatment cohorts. Cox proportional-hazards regressions and Kaplan-Meier survival curves were used to estimate the association between DOACs and the risk of ICH compared with warfarin.</jats:p> </jats:sec> <jats:sec> <jats:title>Results—</jats:title> <jats:p> The combined cohort of 218 620 patients had a median follow-up of 3.0 months, mean age of 55.4 years, and was 52.1% women. The DOAC cohort had 26 980 patients and 8 ICH events (1.0 cases per 1000 person-years), and the warfarin cohort had 191 640 patients and 324 ICH events (3.3 cases per 1000 person-years; <jats:italic>P</jats:italic> <0.0001). The DOAC cohort had a lower hazard ratio for ICH compared with warfarin in both the unmatched (hazard ratio=0.26; <jats:italic>P</jats:italic> =0.0002) and matched (hazard ratio=0.20; <jats:italic>P</jats:italic> =0.0001) Cox proportional-hazards regressions. </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>DOACs show superior safety to warfarin in terms of risk of ICH in patients with DVT/PE.</jats:p> </jats:sec> Direct Oral Anticoagulants Versus Warfarin Intracranial Hemorrhage in Deep Vein Thrombosis/Pulmonary Embolus Patients Without Atrial Fibrillation : Direct Oral Anticoagulants Versus Warfarin Stroke |
| doi_str_mv |
10.1161/strokeaha.118.022156 |
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Online Free |
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Medizin |
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Ovid Technologies (Wolters Kluwer Health), 2018 |
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Ovid Technologies (Wolters Kluwer Health), 2018 |
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0039-2499 1524-4628 |
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Ovid Technologies (Wolters Kluwer Health) |
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ai |
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ai |
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Stroke |
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49 |
| title_sub |
Direct Oral Anticoagulants Versus Warfarin |
| title |
Intracranial Hemorrhage in Deep Vein Thrombosis/Pulmonary Embolus Patients Without Atrial Fibrillation : Direct Oral Anticoagulants Versus Warfarin |
| title_unstemmed |
Intracranial Hemorrhage in Deep Vein Thrombosis/Pulmonary Embolus Patients Without Atrial Fibrillation : Direct Oral Anticoagulants Versus Warfarin |
| title_full |
Intracranial Hemorrhage in Deep Vein Thrombosis/Pulmonary Embolus Patients Without Atrial Fibrillation : Direct Oral Anticoagulants Versus Warfarin |
| title_fullStr |
Intracranial Hemorrhage in Deep Vein Thrombosis/Pulmonary Embolus Patients Without Atrial Fibrillation : Direct Oral Anticoagulants Versus Warfarin |
| title_full_unstemmed |
Intracranial Hemorrhage in Deep Vein Thrombosis/Pulmonary Embolus Patients Without Atrial Fibrillation : Direct Oral Anticoagulants Versus Warfarin |
| title_short |
Intracranial Hemorrhage in Deep Vein Thrombosis/Pulmonary Embolus Patients Without Atrial Fibrillation : Direct Oral Anticoagulants Versus Warfarin |
| title_sort |
intracranial hemorrhage in deep vein thrombosis/pulmonary embolus patients without atrial fibrillation : direct oral anticoagulants versus warfarin |
| topic |
Advanced and Specialized Nursing Cardiology and Cardiovascular Medicine Neurology (clinical) |
| url |
http://dx.doi.org/10.1161/strokeaha.118.022156 |
| publishDate |
2018 |
| physical |
1866-1871 |
| description |
<jats:sec>
<jats:title>Background and Purpose—</jats:title>
<jats:p>Deep vein thrombosis (DVTs) is a common disease with high morbidity if it progresses to pulmonary embolus (PE). Anticoagulation is the treatment of choice; warfarin has long been the standard of care. Early experience with direct oral anticoagulants (DOACs) suggests that these agents may be may be a safer and equally effective alternative in the treatment of DVT/PE. Nontraumatic intracranial hemorrhage (ICH) is one of the most devastating potential complications of anticoagulation therapy. We sought to compare the rates of ICH in patients treated with DOACs versus those treated with warfarin for DVT/PE.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods—</jats:title>
<jats:p>The MarketScan Commercial Claims and Medicare Supplemental databases were used. Adult DVT/PE patients without known atrial fibrillation and with prescriptions for either a DOAC or warfarin were followed for the occurrence of inpatient admission for ICH. Coarsened exact matching was used to balance the treatment cohorts. Cox proportional-hazards regressions and Kaplan-Meier survival curves were used to estimate the association between DOACs and the risk of ICH compared with warfarin.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results—</jats:title>
<jats:p>
The combined cohort of 218 620 patients had a median follow-up of 3.0 months, mean age of 55.4 years, and was 52.1% women. The DOAC cohort had 26 980 patients and 8 ICH events (1.0 cases per 1000 person-years), and the warfarin cohort had 191 640 patients and 324 ICH events (3.3 cases per 1000 person-years;
<jats:italic>P</jats:italic>
<0.0001). The DOAC cohort had a lower hazard ratio for ICH compared with warfarin in both the unmatched (hazard ratio=0.26;
<jats:italic>P</jats:italic>
=0.0002) and matched (hazard ratio=0.20;
<jats:italic>P</jats:italic>
=0.0001) Cox proportional-hazards regressions.
</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions—</jats:title>
<jats:p>DOACs show superior safety to warfarin in terms of risk of ICH in patients with DVT/PE.</jats:p>
</jats:sec> |
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| author | Lamsam, Layton, Sussman, Eric S., Iyer, Aditya K., Bhambhvani, Hriday P., Han, Summer S., Skirboll, Stephen, Ratliff, John K. |
| author_facet | Lamsam, Layton, Sussman, Eric S., Iyer, Aditya K., Bhambhvani, Hriday P., Han, Summer S., Skirboll, Stephen, Ratliff, John K., Lamsam, Layton, Sussman, Eric S., Iyer, Aditya K., Bhambhvani, Hriday P., Han, Summer S., Skirboll, Stephen, Ratliff, John K. |
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| description | <jats:sec> <jats:title>Background and Purpose—</jats:title> <jats:p>Deep vein thrombosis (DVTs) is a common disease with high morbidity if it progresses to pulmonary embolus (PE). Anticoagulation is the treatment of choice; warfarin has long been the standard of care. Early experience with direct oral anticoagulants (DOACs) suggests that these agents may be may be a safer and equally effective alternative in the treatment of DVT/PE. Nontraumatic intracranial hemorrhage (ICH) is one of the most devastating potential complications of anticoagulation therapy. We sought to compare the rates of ICH in patients treated with DOACs versus those treated with warfarin for DVT/PE.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods—</jats:title> <jats:p>The MarketScan Commercial Claims and Medicare Supplemental databases were used. Adult DVT/PE patients without known atrial fibrillation and with prescriptions for either a DOAC or warfarin were followed for the occurrence of inpatient admission for ICH. Coarsened exact matching was used to balance the treatment cohorts. Cox proportional-hazards regressions and Kaplan-Meier survival curves were used to estimate the association between DOACs and the risk of ICH compared with warfarin.</jats:p> </jats:sec> <jats:sec> <jats:title>Results—</jats:title> <jats:p> The combined cohort of 218 620 patients had a median follow-up of 3.0 months, mean age of 55.4 years, and was 52.1% women. The DOAC cohort had 26 980 patients and 8 ICH events (1.0 cases per 1000 person-years), and the warfarin cohort had 191 640 patients and 324 ICH events (3.3 cases per 1000 person-years; <jats:italic>P</jats:italic> <0.0001). The DOAC cohort had a lower hazard ratio for ICH compared with warfarin in both the unmatched (hazard ratio=0.26; <jats:italic>P</jats:italic> =0.0002) and matched (hazard ratio=0.20; <jats:italic>P</jats:italic> =0.0001) Cox proportional-hazards regressions. </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>DOACs show superior safety to warfarin in terms of risk of ICH in patients with DVT/PE.</jats:p> </jats:sec> |
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| spelling | Lamsam, Layton Sussman, Eric S. Iyer, Aditya K. Bhambhvani, Hriday P. Han, Summer S. Skirboll, Stephen Ratliff, John K. 0039-2499 1524-4628 Ovid Technologies (Wolters Kluwer Health) Advanced and Specialized Nursing Cardiology and Cardiovascular Medicine Neurology (clinical) http://dx.doi.org/10.1161/strokeaha.118.022156 <jats:sec> <jats:title>Background and Purpose—</jats:title> <jats:p>Deep vein thrombosis (DVTs) is a common disease with high morbidity if it progresses to pulmonary embolus (PE). Anticoagulation is the treatment of choice; warfarin has long been the standard of care. Early experience with direct oral anticoagulants (DOACs) suggests that these agents may be may be a safer and equally effective alternative in the treatment of DVT/PE. Nontraumatic intracranial hemorrhage (ICH) is one of the most devastating potential complications of anticoagulation therapy. We sought to compare the rates of ICH in patients treated with DOACs versus those treated with warfarin for DVT/PE.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods—</jats:title> <jats:p>The MarketScan Commercial Claims and Medicare Supplemental databases were used. Adult DVT/PE patients without known atrial fibrillation and with prescriptions for either a DOAC or warfarin were followed for the occurrence of inpatient admission for ICH. Coarsened exact matching was used to balance the treatment cohorts. Cox proportional-hazards regressions and Kaplan-Meier survival curves were used to estimate the association between DOACs and the risk of ICH compared with warfarin.</jats:p> </jats:sec> <jats:sec> <jats:title>Results—</jats:title> <jats:p> The combined cohort of 218 620 patients had a median follow-up of 3.0 months, mean age of 55.4 years, and was 52.1% women. The DOAC cohort had 26 980 patients and 8 ICH events (1.0 cases per 1000 person-years), and the warfarin cohort had 191 640 patients and 324 ICH events (3.3 cases per 1000 person-years; <jats:italic>P</jats:italic> <0.0001). The DOAC cohort had a lower hazard ratio for ICH compared with warfarin in both the unmatched (hazard ratio=0.26; <jats:italic>P</jats:italic> =0.0002) and matched (hazard ratio=0.20; <jats:italic>P</jats:italic> =0.0001) Cox proportional-hazards regressions. </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>DOACs show superior safety to warfarin in terms of risk of ICH in patients with DVT/PE.</jats:p> </jats:sec> Direct Oral Anticoagulants Versus Warfarin Intracranial Hemorrhage in Deep Vein Thrombosis/Pulmonary Embolus Patients Without Atrial Fibrillation : Direct Oral Anticoagulants Versus Warfarin Stroke |
| spellingShingle | Lamsam, Layton, Sussman, Eric S., Iyer, Aditya K., Bhambhvani, Hriday P., Han, Summer S., Skirboll, Stephen, Ratliff, John K., Stroke, Intracranial Hemorrhage in Deep Vein Thrombosis/Pulmonary Embolus Patients Without Atrial Fibrillation : Direct Oral Anticoagulants Versus Warfarin, Advanced and Specialized Nursing, Cardiology and Cardiovascular Medicine, Neurology (clinical) |
| title | Intracranial Hemorrhage in Deep Vein Thrombosis/Pulmonary Embolus Patients Without Atrial Fibrillation : Direct Oral Anticoagulants Versus Warfarin |
| title_full | Intracranial Hemorrhage in Deep Vein Thrombosis/Pulmonary Embolus Patients Without Atrial Fibrillation : Direct Oral Anticoagulants Versus Warfarin |
| title_fullStr | Intracranial Hemorrhage in Deep Vein Thrombosis/Pulmonary Embolus Patients Without Atrial Fibrillation : Direct Oral Anticoagulants Versus Warfarin |
| title_full_unstemmed | Intracranial Hemorrhage in Deep Vein Thrombosis/Pulmonary Embolus Patients Without Atrial Fibrillation : Direct Oral Anticoagulants Versus Warfarin |
| title_short | Intracranial Hemorrhage in Deep Vein Thrombosis/Pulmonary Embolus Patients Without Atrial Fibrillation : Direct Oral Anticoagulants Versus Warfarin |
| title_sort | intracranial hemorrhage in deep vein thrombosis/pulmonary embolus patients without atrial fibrillation : direct oral anticoagulants versus warfarin |
| title_sub | Direct Oral Anticoagulants Versus Warfarin |
| title_unstemmed | Intracranial Hemorrhage in Deep Vein Thrombosis/Pulmonary Embolus Patients Without Atrial Fibrillation : Direct Oral Anticoagulants Versus Warfarin |
| topic | Advanced and Specialized Nursing, Cardiology and Cardiovascular Medicine, Neurology (clinical) |
| url | http://dx.doi.org/10.1161/strokeaha.118.022156 |