- 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.
- 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.
- 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).
- Small sample size.
- Observational study design.
- "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.