Non-recommended dosing of direct oral anticoagulants in the treatment of acute pulmonary embolism is related to an increased rate of adverse events |
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| Authors: | Romain Chopard Guillaume Serzian Sébastien Humbert Nicolas Falvo Mathilde Morel-Aleton Benjamin Bonnet Gabriel Napporn Elsa Kalbacher Laurent Obert Bruno Degano Gilles Cappelier Yves Cottin François Schiele Nicolas Meneveau |
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| Affiliation: | 1.Department of Cardiology, EA3920,University Hospital Besan?on,Besan?on,France;2.Department of Internal Medicine,Hospital Besan?on,Besan?on,France;3.Department of Internal Medicine,University Hospital,Dijon,France;4.Department of Cardiology,General Hospital,Pontarlier,France;5.Department of Cardiology,General Hospital of Vesoul,Vesoul,France;6.Department of Cardiology,Hospital Center Louis Pasteur,Dole,France;7.Medical Oncology Unit,University Hospital Besan?on,Besan?on,France;8.Orthopedic, Trauma, Plastic, Reconstructive and Hand Surgery Department,University Hospital Besan?on,Besan?on,France;9.Department of Physiology, EA3920,University Hospital Besan?on,Besan?on,France;10.Medical Intensive Care Unit, EA3920,University Hospital Besan?on,Besan?on,France;11.Department of Cardiology,University Hospital,Dijon,France |
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| Abstract: | Dose adjustment of direct oral anticoagulants (DOACs) is not required in the setting of acute PE treatment according to the manufacturer’s labelling, beyond the contraindication in severe renal insufficiency. We designed a prospective, multicenter cohort study to investigate the impact of prescription of non-recommended DOAC doses on 6-month adverse events. The primary endpoint was a composite of all-cause death, recurrent VTE, major bleeding, and chronic thromboembolic pulmonary hypertension (CTEPH). In total, among 656 patients discharged with DOACs between 09/2012 and 10/2016, 28 (4.3%) were not treated with a recommended DOAC dose. All the non-recommended DOAC dose prescriptions were under-dosed according to the drug labelling. After multivariate adjustment, age?>?70 years, a history of coronary artery disease, creatinine clearance?
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