Clinical outcomes in lower extremity deep vein thrombosis treated with a direct oral anticoagulant: A retrospective cohort study

Abstract

Background/Aim: Rivaroxaban and apixaban were shown to be non-inferior and somewhat superior to warfarin in preventing pulmonary embolization and venous complications. However, there is still a need for further evidence concerning the efficacy and safety of direct oral anticoagulants in the treatment of patients with deep vein thrombosis (DVT) and pulmonary embolism (PE). This study aimed to analyze patients with DVT and PE who received a direct oral anticoagulant (apixaban) during their hospitalization and thereafter. Methods: Data of all consecutive subjects admitted for lower limb DVT who received apixaban for DVT treatment in our department between January 2015-April 2019 were analyzed. Apixaban was directly administered after the diagnosis of DVT in 68 subjects, following discontinuation of warfarin due to the lack of success in maintaining appropriate INR values in 56 subjects and following the discontinuation of the rivaroxaban due to gastrointestinal complications in 7 subjects. Results: Apixaban was administered for a median duration of 12.0 (12.0-24.0) months. The most common predisposing factors for venous thromboembolism were thrombophilia and major surgery history. Among all, 62.59% of the DVT were at and proximal to the femoral vein. Concomitant PE was encountered in 16.03% of the study subjects. Those with distal DVT and those who received apixaban immediately after diagnosis of the DVT less frequently developed PE compared to those who received post-rivaroxaban or post-warfarin apixaban. Treatment with apixaban leads to a significant decline in D-dimer levels from the first month of the treatment (P<0.001). Recurrent DVT and PE occur in 10% and 16%, respectively, under apixaban treatment. Conclusions: Among patients with proximal DVT, those receiving apixaban following a period of treatment with rivaroxaban or warfarin compared to direct administration constitute the majority of the PE cases. Apixaban seems like an effective treatment option in patients with DVT and PE.