Oral Rivaroxaban Versus Warfarin After inferior Vena cava Filter Implantation: A Retrospective Cohort Study

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Deep vein thrombosis with inferior vena cava filter implantation (n=100). Intervention: Rivaroxaban vs. Warfarin (target INR 2.0-3.0). Primary outcome: Symptomatic VTE recurrence confirmed by imaging (including PE, DVT, and IVC occlusion) at 12 months (p=0.066).

Q: What does this research mean for the field?

Rivaroxaban is at least as effective and safe as warfarin for preventing recurrent venous thromboembolism after inferior vena cava filter implantation without increasing bleeding risk. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ilya Schastlivtsev; A. S. Pankov; Sergey Tsaplin; Evgeny Stepanov; Sergey Zhuravlev; Kirill Lobastov

doi:10.1177/10760296241256938

January 1, 2024Clinical and Applied Thrombosis/HemostasisOpen Access

Oral Rivaroxaban Versus Warfarin After inferior Vena cava Filter Implantation: A Retrospective Cohort Study

View Full Paper

Ask AI

Bookmark

Share

Key result

Rivaroxaban linked to zero recurrent VTE vs. ~7% with warfarin after IVC filter placement.

P=0.066
n=100

Figures

Why the study?

The study was conducted to assess the efficacy and safety of rivaroxaban compared to warfarin after inferior vena cava filter implantation.

Does oral rivaroxaban reduce symptomatic VTE recurrence and major bleeding compared to warfarin in patients with DVT after IVC filter implantation?

Key Points

To assess the efficacy and safety of oral rivaroxaban compared to warfarin following inferior vena cava (IVC) filter implantation.
Retrospective cohort analysis of 100 patients with deep vein thrombosis who received an IVC filter between 2012 and 2018.
Patients received either warfarin (n = 41) or rivaroxaban (n = 59) for 3 to 12 months, with follow-up extending to 12 months.
Outcomes evaluated included symptomatic venous thromboembolism (VTE) recurrence, IVC filter occlusion, and bleeding complications, analyzed before and after propensity score matching.
Symptomatic VTE recurrence occurred in 3 (7.3%) patients on warfarin and 0 (0%) on rivaroxaban, with no IVC filter occlusions reported in either group (log-rank P = 0.035).
Major bleeding occurred in 1 (2.4%) patient taking warfarin, while clinically relevant non-major bleeding occurred in 3 (5.1%) patients taking rivaroxaban (log-rank P = 0.512).
Direct group comparisons and propensity score matching (21 patients per group) revealed no statistically significant differences in outcomes between rivaroxaban and warfarin.

Study Design

Type

Cohort (n=100)

Multicenter

No

Structured PICO

Does oral rivaroxaban reduce symptomatic VTE recurrence and major bleeding compared to warfarin in patients with DVT after IVC filter implantation?

P

Population

100 adults with confirmed deep vein thrombosis who underwent inferior vena cava filter implantation in Russia (mean age 62.2 years, 46% female), followed for 12 months.

E

Exposure

Rivaroxaban oral (15 mg twice daily for 21 days followed by 20 mg once daily) for 3 to 12+ months, preceded by initial therapeutic anticoagulation with low-molecular-weight heparin (LMWH, enoxaparin 1 mg/kg twice daily or equivalent) for 2-10 days (mean 3.4 ± 1.6 days in rivaroxaban group).

C

Comparator

Warfarin oral with a target INR of 2.0-3.0 for 3 to 12+ months, preceded by initial therapeutic anticoagulation with LMWH (enoxaparin 1 mg/kg twice daily or equivalent) for 2-10 days (mean 9.0 ± 3.7 days in warfarin group).

O

Outcome

Primary efficacy endpoint: symptomatic venous thromboembolism (VTE) recurrence confirmed by medical imaging (duplex ultrasound or CT pulmonary angiography), including pulmonary embolism (PE), DVT, and IVC occlusion, at 12 months follow-up after discharge. Primary safety outcome: major bleeding according to International Society on Thrombosis and Haemostasis criteria at 12 months follow-up.composite

Main Result

Absolute Event Rate: 0% vs 7.3%

p-value: p=0.066

In this retrospective cohort of 100 DVT patients with IVC filters, oral rivaroxaban demonstrated comparable efficacy and safety to warfarin over 12 months with zero VTE recurrences or major bleeding events in the rivaroxaban arm.

Limitations

Historical control group treated with warfarin introducing time bias
Relatively short 12-month follow-up duration
Small sample size limiting statistical power and propensity score matching
Lack of reliable data on INR dynamics in the warfarin group
Historical control group of patients treated with warfarin raising a time bias
Relatively short follow-up limited to 12 months
Relatively small sample size to provide statistically significant differences and make a robust propensity score matching
Lack of reliable information on the dynamics of the international normalized ratio (INR) for patients on warfarin

Implication

Rivaroxaban was associated with fewer VTE recurrences after IVC filter; leaves open superiority to warfarin in randomized trials.

Abstract

OBJECTIVES: To assess the efficacy and safety of rivaroxaban compared to warfarin after inferior vena cava (IVC) filter implantation. METHOD: This retrospective analysis includes data from 100 patients with deep vein thrombosis (DVT) who underwent IVC filter implantation due to a free-floating thrombus (n = 64), thrombus propagation (n = 8), or acute bleeding (n = 8) on therapeutic anticoagulation, catheter-directed thrombolysis (n = 8), or had previously implanted filter with DVT recurrence. Patients were treated with warfarin (n = 41) or rivaroxaban (n = 59) for 3-12 months. Symptomatic venous thromboembolism (VTE) recurrence and bleeding events were assessed at 12 months follow-up. RESULTS: Three (7.3%) cases of VTE recurrence without IVC filter occlusion occurred on warfarin and none on rivaroxaban. The only (2.4%) major bleeding occurred on warfarin. Three (5.1%) clinically relevant non-major bleedings were detected on rivaroxaban. No significant differences existed between groups when full and propensity scores matched datasets were compared. CONCLUSIONS: Rivaroxaban seems not less effective and safe than warfarin after IVC filter implantation.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Schastlivtsev et al. (2024) conducted a cohort in Deep vein thrombosis with inferior vena cava filter implantation (n=100). Rivaroxaban vs. Warfarin (target INR 2.0-3.0) was evaluated on Symptomatic VTE recurrence confirmed by imaging (including PE, DVT, and IVC occlusion) at 12 months (p=0.066). Rivaroxaban resulted in 0% symptomatic VTE recurrence compared to 7.3% with warfarin (p=0.066; log-rank p=0.035) at 12 months after IVC filter implantation.

synapsesocial.com/papers/6a75b63950ae15bd7fd377cb https://doi.org/10.1177/10760296241256938

View Full Paper

Ask AI

Bookmark

Share

Oral Rivaroxaban Versus Warfarin After inferior Vena cava Filter Implantation: A Retrospective Cohort Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Oral Rivaroxaban Versus Warfarin After inferior Vena cava Filter Implantation: A Retrospective Cohort Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading