Article Sidebar
Published:
Nov 24, 2020Keywords:
Article Details
Submission of a manuscript to this journal is a representation that the manuscript has not been published previously and is not under consideration for publication elsewhere.
All authors named in each manuscript would be required to sign a form (to be supplied by the Editor) so that they may retain their copyright in the article but to assign to us (the Publishers) and its licensees in perpetuity, in all forms, formats and media (whether known or created in the future) to (i) publish, reproduce, distribute, display and store the contribution, (ii) translate the contribution into other languages, create adaptations, reprints, include within collections and create summaries, extracts and/or abstracts of the contribution, (iii) create any other derivative works(s) based on the contribution, (iv) to exploit all subsidiary rights in the contribution, (v) the inclusion of electronic links from the contribution to third party material where-ever it may be located, and (vi) license any thrid party to do any or all of the above.
Main Article Content
Extended warfarin treatment versus rivaroxaban treatment for first episode of symptomatic unprovoked pulmonary embolism: A prospective cohort study
Abstract
Purpose: To compare the benefits and risks of extra 6 months of warfarin therapy with those of rivaroxaban treatment in patients with initial unprovoked pulmonary embolism (PE) episode who completed 3- or 6-month of therapy on heparin/vitamin K antagonist standard regime.
Methods: This prospective observational study included 212 patients with follow-up from July 2013 to July 2018. The primary endpoint was symptomatic recurrent venous thromboembolism (VT), composite of non-fatal symptomatic PE or deep vein thrombosis or fatal VT, and major bleeding (non-fatal/fatal) up to 6 months. Secondary endpoints were death not related to PE or major bleeding.
Results: During the 6-month therapy period, the primary endpoint was seen in 3 out of 106 patients (2.83 %) in warfarin category, and in rivaroxaban category, for a hazard ratio (HR) of 1.22 [95 % confidence interval (CI) = 0.09 - 11.18; p = 0.813]. With warfarin therapy, 2 patients (1.89 %) had recurrent VT, while 3 patients (2.83 %) had VT with rivaroxaban. Major bleeding was observed in 2 patients (1.89 %) on warfarin, and in one patient (0.94 %) on rivaroxaban. During the entire 18-month period, the primary endpoint was seen in 15 patients (14.15 %) treated with warfarin, and in 18 patients (16.98 %) treated with rivaroxaban (HR 0.84; 95 % CI = 0.47 - 1.84; p = 0.431). Major bleeding was observed in 5 patients (4.72 %) under warfarin (one fatal), relative to 3 patients (2.83 %) under rivaroxaban (R 1.67; 95 % CI = 0.62 - 5.95; p = 0.09).
Conclusion: Rivaroxaban showed higher efficacy than warfarin in recurrent VT prevention, with lower risk of major bleeding. However, the extended therapeutic benefit was not maintained post-therapy.
Keywords: Pulmonary embolism, Rivaroxaban, Warfarin, Heparin, Vitamin K, Hazard ratio
