Clinical and Applied Thrombosis/Hemostasis (Mar 2023)

Retrospective Analysis of Direct-Acting Oral Anticoagulants (DOACs) Initiation Timing and Outcomes After Thrombolysis in High- and Intermediate-Risk Pulmonary Embolism

  • Adam Wolfe MD,
  • Angela Phillips MD,
  • David M Tierney MD, FACP,
  • Roman Melamed MD, FCCP,
  • Ghazi Qadri MD,
  • Matthew Lillyblad PharmD, BCCCP, BCCP,
  • Claire Smith MS,
  • Catherine St. Hill DVM, PhD,
  • Ashley E Stenzel PhD,
  • David Beddow MD,
  • Justin Kirven MD,
  • Rajesh Kethireddy MD,
  • Love Patel MD, SFHM

DOI
https://doi.org/10.1177/10760296231156414
Journal volume & issue
Vol. 29

Abstract

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Direct-acting oral anticoagulants (DOACs) are prescribed in the treatment of venous thromboembolism, including pulmonary embolism (PE). Evidence is limited regarding the outcomes and optimal timing of DOACs in patients with intermediate- or high-risk PE treated with thrombolysis. We conducted a retrospective analysis of outcomes among patients with intermediate- and high-risk PE who received thrombolysis, by choice of long-term anticoagulant agent. Outcomes of interest included hospital length of stay (LOS), intensive care unit LOS, bleeding, stroke, readmission, and mortality. Descriptive statistics were used to examine characteristics and outcomes among patients, by anticoagulation group. Patients receiving a DOAC (n = 53) had shorter hospital LOS compared to those in warfarin (n = 39) and enoxaparin (n = 10) groups (mean LOS 3.6, 6.3 and 4.5 days, respectively; P < .0001). This single institution retrospective study suggests DOAC initiation <48 h from thrombolysis may result in shorter hospital LOS compared to DOAC initiation ≥48 h ( P < .0001). Further larger studies with more robust research methodology are needed to address this important clinical question.