Direct Oral to Parenteral Anticoagulants: Strategies for Inpatient Transition.
Administration, Intravenous
Administration, Oral
Aged
Aged, 80 and over
Anticoagulants
/ administration & dosage
Factor Xa Inhibitors
/ administration & dosage
Female
Hemorrhage
/ chemically induced
Humans
Inpatients
International Normalized Ratio
Kidney Function Tests
Male
Middle Aged
Organ Dysfunction Scores
Patient Acuity
Prospective Studies
Risk Factors
Thrombosis
/ epidemiology
Time Factors
anticoagulants
apixaban
bleeding
factor Xa inhibitors
inpatients
rivaroxaban
Journal
Journal of clinical pharmacology
ISSN: 1552-4604
Titre abrégé: J Clin Pharmacol
Pays: England
ID NLM: 0366372
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
29
05
2020
accepted:
16
06
2020
pubmed:
9
7
2020
medline:
15
12
2021
entrez:
9
7
2020
Statut:
ppublish
Résumé
The primary objective of this study was to describe the impact on bleeding rates of 2 different strategies for transitioning from a direct oral anticoagulant (DOAC) to a parenteral anticoagulant: a delayed, clinically driven strategy versus the standard per-package-insert strategy. This was a single-center descriptive cohort study conducted at a large academic medical center. Included patients were 18 years or older, admitted as an inpatient, and had received at least 1 dose of a DOAC prior to initiation of therapeutic parenteral anticoagulation. The primary end point was the incidence of major bleeds on the transition from a DOAC to a parenteral anticoagulant via a standard versus an intentionally delayed strategy. The secondary outcomes evaluated renal function, reason for delay, DOAC anti-factor Xa concentration, international normalized ratio values, blood product administration, and thrombotic complications. A total of 300 patients were included. The primary end point of bleeding was higher in the delayed group than the standard group, 25% and 12%, respectively (odds ratio, 0.39; P < .05). In both groups, patients who bled had a higher severity of illness, a greater incidence of acute kidney injury, and, when available, higher median DOAC anti-factor Xa concentrations. Despite a more conservative approach, patients in the delayed group experienced more bleeding, most likely attributable to a higher severity of illness, which highlights emerging challenges of inpatient anticoagulation management. Further prospective studies analyzing DOAC pharmacodynamics and pharmacokinetics in acutely ill patients are warranted.
Substances chimiques
Anticoagulants
0
Factor Xa Inhibitors
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
32-40Informations de copyright
© 2020, The American College of Clinical Pharmacology.
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