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Rivaroxaban for the treatment of venous thromboembolism

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
DOI: https://doi.org/10.1160/TH16-03-0209
Issue: 2016: 116/3 (Sep) pp. 403–585
Pages: 472-479
Ahead of Print: 2016-06-23

Rivaroxaban for the treatment of venous thromboembolism

The SWIss Venous ThromboEmbolism Registry (SWIVTER)

N. Kucher (1), D. Aujesky (2), J. H. Beer (3), L. Mazzolai (4), T. Baldi (5), M. Banyai (6), D. Hayoz (7), T. Kaeslin (8), W. Korte (9), R. Escher (10), M. Husmann (11), B. Frauchiger (12), I. Baumgartner (1), D. Spirk (13)

(1) Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; (2) Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland; (3) Department of Internal Medicine, Cantonal Hospital Baden, Baden, Switzerland; (4) Clinic of Angiology, University Hospital Lausanne, Lausanne, Switzerland; (5) Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; (6) Department of Internal Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland; (7) Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland; (8) Department of Internal Medicine, Cantonal Hospital Obwalden, Sarnen, Switzerland; (9) Department of Internal Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; (10) Department of Internal Medicine, Regional Hospital Burgdorf, Burgdorf, Switzerland; (11) Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland; (12) Department of Internal Medicine, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland; (13) Institute of Pharmacology, University Bern, Bern, Switzerland

Keywords

venous thromboembolism, anticoagulation, rivaroxaban

Summary

We investigated three-month clinical outcomes in patients with venous thromboembolism (VTE) treated with rivaroxaban or conventional anticoagulation in routine clinical practice. Between November 2012 and February 2015, 2,062 consecutive patients with VTE from 11 acute care hospitals in Switzerland were enrolled in the SWIss Venous ThromboEmbolism Registry (SWIVTER). Overall, 417 (20 %) patients were treated with rivaroxaban. In comparison to 1,645 patients on conventional anticoagulation, patients on rivaroxaban were younger (56 ± 18 vs. 65 ± 17 years; p<0.001), less often had pulmonary embolism (38 % vs 66 %; p<0.001), hypertension (26 % vs 41 %; p<0.001), cancer (10 % vs 28 %; p<0.001), congestive heart failure (10 % vs 17 %; p=0.001), diabetes (8 % vs 15 %; p<0.001), chronic lung disease (7 % vs 13 %; p=0.001), renal insufficiency (7 % vs 13 %; p=0.001), recent surgery (7 % vs 14 %; p<0.001), and acute coronary syndrome (1 % vs 4 %; p=0.009). VTE reperfusion therapy was more frequently used (28 % vs 9 %; p<0.001) and indefinite-duration anticoagulation treatment less often planned (26 % vs 39 %; p<0.001), respectively. In the propensity score-adjusted population, the risk of recurrent VTE was similar in patients on rivaroxaban vs conventional anticoagulation (1.2 % vs 2.1 %, hazard ratio [HR] 0.55, 95 % confidence interval [CI] 0.18–1.65; p=0.29); the risk of major bleeding was also similar, respectively (0.5 % vs 0.5 %, HR 1.00, 95 %CI 0.14–7.07; p=1.00). Conventional anticoagulation is still frequently used for the treatment of VTE, particularly in the elderly and those with comorbidities. Early clinical outcomes were comparable between propensity score-adjusted patient populations on rivaroxaban and conventional anticoagulation.

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