Outcomes of venous thromboembolism in patients with inherited thrombophilia treated with direct oral anticoagulants: insights from the RIETE registry
While direct oral anticoagulants (DOACs) are frequently used to treat venous thromboembolism (VTE), the outcomes of patients with inherited thrombophilia (IT) receiving DOACs for VTE remain understudied. We used data from the international RIETE registry to compare the rates of VTE recurrences, majo...
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| Veröffentlicht in: | Journal of thrombosis and thrombolysis 2024-04, Vol.57 (4), p.710-720 |
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| creator | Cohen, Omri Kenet, Gili Levy-Mendelovich, Sarina Tzoran, Inna Brenner, Benjamin De Ancos, Cristina López-Miguel, Patricia Varona, José F. Catella, Judith Monreal, Manuel |
| description | While direct oral anticoagulants (DOACs) are frequently used to treat venous thromboembolism (VTE), the outcomes of patients with inherited thrombophilia (IT) receiving DOACs for VTE remain understudied. We used data from the international RIETE registry to compare the rates of VTE recurrences, major bleeding, and mortality during anticoagulant treatment in VTE patients with and without IT, grouped by the use of DOACs or standard anticoagulant therapy. Among 103,818 enrolled patients, 21,089 (20.3%) were tested for IT, of whom 8422 (39.9%) tested positive: Protein C deficiency 294, Protein S deficiency 726, Antithrombin deficiency 240, Factor V Leiden 2248, Prothrombin gene mutation 1434, combined IT 3480. Overall, 14,189 RIETE patients (6.2% with IT) received DOACs, and 89,629 standard anticoagulation (8.4% with IT), mostly with heparins followed by vitamin K antagonists. Proportions of patients receiving DOACs did not differ between IT-positive and IT-negative patients. Rates of VTE recurrence on anticoagulant treatment were highest in patients with AT deficiency (
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| doi_str_mv | 10.1007/s11239-024-02957-4 |
| format | Article |
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P
< 0.01). Rates of on-treatment major bleeding and all-cause mortality were lowest among patients with Factor V Leiden (FVL) or PT G20210A mutations, compared with patients who tested negative. Patients with IT who received DOACs had lower rates of major bleeding than those receiving standard anticoagulation. Excluding FVL and Protein S deficiency, patients with IT had lower rates of VTE recurrence with DOACs than with standard anticoagulation. DOACs are equally safe and effective in VTE patients with IT, with lower bleeding rates than those on standard anticoagulation.</description><identifier>ISSN: 1573-742X</identifier><identifier>ISSN: 0929-5305</identifier><identifier>EISSN: 1573-742X</identifier><identifier>DOI: 10.1007/s11239-024-02957-4</identifier><identifier>PMID: 38491267</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Antagonists ; Anticoagulants ; Antithrombin ; Bleeding ; Cardiology ; Coagulation factors ; Factor V ; Hematology ; Medicine ; Medicine & Public Health ; Mortality ; Mutation ; Point mutation ; Protein C ; Protein deficiency ; Protein S ; Proteins ; Prothrombin ; Prothrombin gene ; Thromboembolism ; Thrombophilia ; Vitamin K</subject><ispartof>Journal of thrombosis and thrombolysis, 2024-04, Vol.57 (4), p.710-720</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-fc0314c4562846a81b376fd491cf831be53446ff7f81a1b49c622358e1743f1a3</cites><orcidid>0000-0002-8328-9748</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11239-024-02957-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11239-024-02957-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38491267$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cohen, Omri</creatorcontrib><creatorcontrib>Kenet, Gili</creatorcontrib><creatorcontrib>Levy-Mendelovich, Sarina</creatorcontrib><creatorcontrib>Tzoran, Inna</creatorcontrib><creatorcontrib>Brenner, Benjamin</creatorcontrib><creatorcontrib>De Ancos, Cristina</creatorcontrib><creatorcontrib>López-Miguel, Patricia</creatorcontrib><creatorcontrib>Varona, José F.</creatorcontrib><creatorcontrib>Catella, Judith</creatorcontrib><creatorcontrib>Monreal, Manuel</creatorcontrib><creatorcontrib>and the RIETE investigators</creatorcontrib><title>Outcomes of venous thromboembolism in patients with inherited thrombophilia treated with direct oral anticoagulants: insights from the RIETE registry</title><title>Journal of thrombosis and thrombolysis</title><addtitle>J Thromb Thrombolysis</addtitle><addtitle>J Thromb Thrombolysis</addtitle><description>While direct oral anticoagulants (DOACs) are frequently used to treat venous thromboembolism (VTE), the outcomes of patients with inherited thrombophilia (IT) receiving DOACs for VTE remain understudied. We used data from the international RIETE registry to compare the rates of VTE recurrences, major bleeding, and mortality during anticoagulant treatment in VTE patients with and without IT, grouped by the use of DOACs or standard anticoagulant therapy. Among 103,818 enrolled patients, 21,089 (20.3%) were tested for IT, of whom 8422 (39.9%) tested positive: Protein C deficiency 294, Protein S deficiency 726, Antithrombin deficiency 240, Factor V Leiden 2248, Prothrombin gene mutation 1434, combined IT 3480. Overall, 14,189 RIETE patients (6.2% with IT) received DOACs, and 89,629 standard anticoagulation (8.4% with IT), mostly with heparins followed by vitamin K antagonists. Proportions of patients receiving DOACs did not differ between IT-positive and IT-negative patients. Rates of VTE recurrence on anticoagulant treatment were highest in patients with AT deficiency (
P
< 0.01). Rates of on-treatment major bleeding and all-cause mortality were lowest among patients with Factor V Leiden (FVL) or PT G20210A mutations, compared with patients who tested negative. Patients with IT who received DOACs had lower rates of major bleeding than those receiving standard anticoagulation. Excluding FVL and Protein S deficiency, patients with IT had lower rates of VTE recurrence with DOACs than with standard anticoagulation. DOACs are equally safe and effective in VTE patients with IT, with lower bleeding rates than those on standard anticoagulation.</description><subject>Antagonists</subject><subject>Anticoagulants</subject><subject>Antithrombin</subject><subject>Bleeding</subject><subject>Cardiology</subject><subject>Coagulation factors</subject><subject>Factor V</subject><subject>Hematology</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Mutation</subject><subject>Point mutation</subject><subject>Protein C</subject><subject>Protein deficiency</subject><subject>Protein S</subject><subject>Proteins</subject><subject>Prothrombin</subject><subject>Prothrombin gene</subject><subject>Thromboembolism</subject><subject>Thrombophilia</subject><subject>Vitamin K</subject><issn>1573-742X</issn><issn>0929-5305</issn><issn>1573-742X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kc9O3DAQxi3UCijtC3CoLPXSS1r_S-JwQ2jbIiEhVSBxsxzveGOUxFvboeJB-r4dWKBVDz2MPBr_5vN4PkKOOfvEGWs_Z86F7ComFEZXt5XaI4e8bmXVKnHz6q_8gLzJ-ZYx1nVM7JMDqVXHRdMekl-XS3Fxgkyjp3cwxyXTMqQ49REwxpAnGma6tSXAXDL9GcqAhQFSKLB-RrdDGIOlJYF9qD5C65DAFRqTHamdS3DRbpYRs3yCAjlsBpTz2I4iQL-fr65WNMEm5JLu35LX3o4Z3j2dR-T6y-rq7Ft1cfn1_Oz0onJSNKXyjkmunKoboVVjNe9l2_g1_s15LXkPtVSq8b71mlveq841QshaA2-V9NzKI_Jxp7tN8ccCuZgpZAcjjgm4CYNb1aJTkklEP_yD3sYlzTidkUxxxrnWHVJiR7kUc07gzTaFyaZ7w5l5MM3sTDNomnk0zShsev8kvfQTrF9anl1CQO6AjFfzBtKft_8j-xswQaTM</recordid><startdate>20240401</startdate><enddate>20240401</enddate><creator>Cohen, Omri</creator><creator>Kenet, Gili</creator><creator>Levy-Mendelovich, Sarina</creator><creator>Tzoran, Inna</creator><creator>Brenner, Benjamin</creator><creator>De Ancos, Cristina</creator><creator>López-Miguel, Patricia</creator><creator>Varona, José F.</creator><creator>Catella, Judith</creator><creator>Monreal, Manuel</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8328-9748</orcidid></search><sort><creationdate>20240401</creationdate><title>Outcomes of venous thromboembolism in patients with inherited thrombophilia treated with direct oral anticoagulants: insights from the RIETE registry</title><author>Cohen, Omri ; Kenet, Gili ; Levy-Mendelovich, Sarina ; Tzoran, Inna ; Brenner, Benjamin ; De Ancos, Cristina ; López-Miguel, Patricia ; Varona, José F. ; Catella, Judith ; Monreal, Manuel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-fc0314c4562846a81b376fd491cf831be53446ff7f81a1b49c622358e1743f1a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Antagonists</topic><topic>Anticoagulants</topic><topic>Antithrombin</topic><topic>Bleeding</topic><topic>Cardiology</topic><topic>Coagulation factors</topic><topic>Factor V</topic><topic>Hematology</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Mutation</topic><topic>Point mutation</topic><topic>Protein C</topic><topic>Protein deficiency</topic><topic>Protein S</topic><topic>Proteins</topic><topic>Prothrombin</topic><topic>Prothrombin gene</topic><topic>Thromboembolism</topic><topic>Thrombophilia</topic><topic>Vitamin K</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cohen, Omri</creatorcontrib><creatorcontrib>Kenet, Gili</creatorcontrib><creatorcontrib>Levy-Mendelovich, Sarina</creatorcontrib><creatorcontrib>Tzoran, Inna</creatorcontrib><creatorcontrib>Brenner, Benjamin</creatorcontrib><creatorcontrib>De Ancos, Cristina</creatorcontrib><creatorcontrib>López-Miguel, Patricia</creatorcontrib><creatorcontrib>Varona, José F.</creatorcontrib><creatorcontrib>Catella, Judith</creatorcontrib><creatorcontrib>Monreal, Manuel</creatorcontrib><creatorcontrib>and the RIETE investigators</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of thrombosis and thrombolysis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cohen, Omri</au><au>Kenet, Gili</au><au>Levy-Mendelovich, Sarina</au><au>Tzoran, Inna</au><au>Brenner, Benjamin</au><au>De Ancos, Cristina</au><au>López-Miguel, Patricia</au><au>Varona, José F.</au><au>Catella, Judith</au><au>Monreal, Manuel</au><aucorp>and the RIETE investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of venous thromboembolism in patients with inherited thrombophilia treated with direct oral anticoagulants: insights from the RIETE registry</atitle><jtitle>Journal of thrombosis and thrombolysis</jtitle><stitle>J Thromb Thrombolysis</stitle><addtitle>J Thromb Thrombolysis</addtitle><date>2024-04-01</date><risdate>2024</risdate><volume>57</volume><issue>4</issue><spage>710</spage><epage>720</epage><pages>710-720</pages><issn>1573-742X</issn><issn>0929-5305</issn><eissn>1573-742X</eissn><abstract>While direct oral anticoagulants (DOACs) are frequently used to treat venous thromboembolism (VTE), the outcomes of patients with inherited thrombophilia (IT) receiving DOACs for VTE remain understudied. We used data from the international RIETE registry to compare the rates of VTE recurrences, major bleeding, and mortality during anticoagulant treatment in VTE patients with and without IT, grouped by the use of DOACs or standard anticoagulant therapy. Among 103,818 enrolled patients, 21,089 (20.3%) were tested for IT, of whom 8422 (39.9%) tested positive: Protein C deficiency 294, Protein S deficiency 726, Antithrombin deficiency 240, Factor V Leiden 2248, Prothrombin gene mutation 1434, combined IT 3480. Overall, 14,189 RIETE patients (6.2% with IT) received DOACs, and 89,629 standard anticoagulation (8.4% with IT), mostly with heparins followed by vitamin K antagonists. Proportions of patients receiving DOACs did not differ between IT-positive and IT-negative patients. Rates of VTE recurrence on anticoagulant treatment were highest in patients with AT deficiency (
P
< 0.01). Rates of on-treatment major bleeding and all-cause mortality were lowest among patients with Factor V Leiden (FVL) or PT G20210A mutations, compared with patients who tested negative. Patients with IT who received DOACs had lower rates of major bleeding than those receiving standard anticoagulation. Excluding FVL and Protein S deficiency, patients with IT had lower rates of VTE recurrence with DOACs than with standard anticoagulation. DOACs are equally safe and effective in VTE patients with IT, with lower bleeding rates than those on standard anticoagulation.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>38491267</pmid><doi>10.1007/s11239-024-02957-4</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-8328-9748</orcidid></addata></record> |
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| subjects | Antagonists Anticoagulants Antithrombin Bleeding Cardiology Coagulation factors Factor V Hematology Medicine Medicine & Public Health Mortality Mutation Point mutation Protein C Protein deficiency Protein S Proteins Prothrombin Prothrombin gene Thromboembolism Thrombophilia Vitamin K |
| title | Outcomes of venous thromboembolism in patients with inherited thrombophilia treated with direct oral anticoagulants: insights from the RIETE registry |
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