Comparaison rivaroxaban apixaban dans le traitement de la MTEV chez les patients patients fragiles : les données du registre RIETE.
Titre original :
Rivaroxaban or apixaban in fragile patients with acute venous thromboembolism
Titre en français :
Rivaroxaban ou apixaban chez les patients fragiles avec MTEV.
Auteurs :
Javier Trujillo-Santos, Patricia Beroiz, Farès Moustafa, Alicia Alonso, Estrella Morejon, Raquel López-Reyes, Ignacio Casado, José Antonio Porras, Katia Flores, Juan J. López-Núñez, Manuel Monreal, RIETE Investigators
Revue :
Thrombosis Research Available online 23 June 2020
Introduction
The efficacy and safety of the direct oral anticoagulants (DOACs) in fragile patients (age ≥ 75 years and/or creatinine clearance [CrCl] levels ≤50 mL/min and/or body weight ≤50kg) with venous thromboembolism (VTE) have not been consistently compared.
Material and methods
We used the RIETE database to compare the rates of the composite of VTE recurrences or major bleeding during anticoagulation in fragile patients with VTE, according to the use of rivaroxaban or apixaban for initial and long-term therapy.
Results
From January 2013 to October 2019, 36,889 patients were recruited, of whom 14,831 (40%) were fragile. Overall, 999 fragile patients (15%) received DOACs starting within the first 48 h: rivaroxaban 711 and apixaban 288. Median duration of therapy was: 113 vs. 111 days. A substantial amount of patients in both subgroups (25% vs. 40%) received non-recommended doses of DOACs. During anticoagulation, 13 patients developed VTE recurrences, 18 had major bleeding and 36 died. When only considering patients receiving recommended doses (n = 705), there were no differences between drugs in the rate of the composite outcome (rate ratio [RR]: 1.08; 95%CI: 0.35–3.30) or all-cause death (RR: 0.99; 95%CI: 0.32–3.08). On multivariable analysis, patients receiving rivaroxaban or apixaban at recommended doses had a similar risk for the composite outcome (hazard ratio: 1.34; 95%CI: 0.35–5.06).
Conclusion
The use of rivaroxaban or apixaban at recommended doses in fragile patients with VTE was associated with a similar risk for VTE recurrences or major bleeding