ACC 2019—DOAC dose reductions tied to adverse events in acute PE


  • Caleb Rans, PharmD
  • Conference Reports
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Takeaway

  • In the treatment of patients with acute pulmonary embolism (PE), use of nonrecommended dosing of direct-acting oral anticoagulants (DOACs) was associated with a higher risk of adverse events.

Why this matters

  • Nonstandard dosing of DOACs could pose a significant risk to patients.
  • Dose reductions are not recommended in acute PE beyond the contraindication in severe renal insufficiency.

Study design

  • A prospective cohort study of 656 patients with acute PE discharged on DOAC therapy.
  • The primary composite endpoint consisted of: all-cause death, recurrent venous thromboembolism (VTE), major bleeding, and chronic thromboembolic pulmonary hypertension (CTEPH) at 6 months.

Key results

  • The primary composite endpoint was higher in patients treated with nonrecommended vs recommended doses (6.1%) (25.0% vs 6.1%; relative risk, 3.19; P<.001>
  • The increased rate of primary endpoint in the nonstandard dosing group was driven by a significantly increased rate of major bleeding (7.1% vs 1.4%; P=.008).

Limitations

  • Small sample size.
  • Observational study design.

Expert comment

  • "Empiric dose reduction of DOACs was associated with 6-month adverse events in our study," said Romain Chopard, MD, PhD, of the Department of Cardiology at the University Hospital Besancon, France.  

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