Why the study?
Bleeding is the most feared and difficult to predict adverse event of anticoagulation, prompting investigation into whether calibrated automated thrombography parameters associate with minor bleeding after venous thromboembolism.
Are calibrated automated thrombography parameters associated with minor bleeding in venous thromboembolism patients on rivaroxaban?
Are calibrated automated thrombography parameters associated with minor bleeding in venous thromboembolism patients on rivaroxaban?
Delayed thrombin generation measured by calibrated automated thrombography prior to the next dose independently predicts minor bleeding in VTE patients on rivaroxaban, but not on VKA.
CAT parameters may flag minor bleeding risk on rivaroxaban; leaves open prospective validation before clinical use.
Bleeding is the most feared and difficult to predict adverse event of anticoagulation. We sought to investigate whether calibrated automated thrombography (CAT) parameters are associated with minor bleeding (MB) in anticoagulated patients following venous thromboembolism (VTE). Enrolled were 132 patients on rivaroxaban, 145 on vitamin K antagonists (VKA) and 31 controls who stopped anticoagulation. Prior to the next dose of the anticoagulant, we measured CAT parameters, along with rivaroxaban concentration and INR. During a median follow-up of 10 months, we recorded minor and major bleedings. On rivaroxaban, 27 (20.5%) patients with MB had longer time to start thrombin generation, lower peak thrombin generation and lower endogenous thrombin potential compared with subjects without MB (all p < 0.001). All CAT parameters, except for peak thrombin generation (p = 0.049), were similar in VKA patients with (n = 25, 17.2%) vs. without MBs. By logistic regression, time to start thrombin generation (p = 0.007) and unprovoked VTE (p = 0.041) independently predicted MBs on rivaroxaban. Major bleedings were more frequent in patients with MBs (17.3% vs. 1.8%, p < 0.001). Abnormal CAT parameters characterize VTE patients prone to MBs on rivaroxaban, but not on VKA. Time to start thrombin generation measured about 24 h since the last rivaroxaban dose might help predict MBs.
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Zalewski et al. (2020) studied this question.
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