PB0418 - Direct oral anticoagulants are preferred over enoxaparin for prevention of catheter complications in patients with cystic fibrosis.

Sunday, June 23, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

PD

Paul P. Dobesh

Professor of Pharmacy Practice and Science
University of Nebraska Medical Center College of Pharmacy
Omaha, Nebraska, United States

Co-Author(s)

HB

Heidi L. Brink

Clinical Pharmacist
Nebraska Medicine
Omaha, Nebraska, United States
EA

Emma D. Alexander

Clinical Pharmacist
University of Nebraska Medical Center College of Pharmacy
Omaha, Nebraska, United States
TB

Theodore A. Blum

Clinical Pharmacist
University of Nebraska Medical Center College of Pharmacy
Omaha, Nebraska, United States
TB

Tara L. Buettner

Clinical Pharmacist
University of Nebraska Medical Center College of Pharmacy
Omaha, Nebraska, United States
EE

Emily P. Evans

Clinical Pharmacist
University of Nebraska Medical Center College of Pharmacy
Omaha, Nebraska, United States
AG

Andrea V. Garcia

Clinical Pharmacist
University of Nebraska Medical Center College of Pharmacy
Omaha, Nebraska, United States
MP

Macy A. Peterson

Clinical Pharmacist
University of Nebraska Medical Center College of Pharmacy
Omaha, Nebraska, United States

Background: Non-pediatric patients with cystic fibrosis (CF) are frequently hospitalized, often requiring placement of a central-venous catheter (CVC). Enoxaparin is commonly used for prevention of catheter-thrombosis but requires daily injections. Direct oral anticoagulants (DOACs) provide a potential oral alternative that may be better accepted by patients.

Aims: Compare the efficacy, safety, and patient acceptance of a DOAC to enoxaparin in non-pediatric patients with CF receiving a CVC.

Methods: This retrospective study included CF patients at our hospital with placement of a CVC who received prophylaxis with either enoxaparin or DOAC between 1/2016 and 6/2023. Patients receiving both anticoagulants were excluded. Patient demographics, medication use, laboratory values, and outcomes were collected from patient charts. Catheter complications included thrombotic events leading to catheter replacement or need for fibrinolytic therapy. All descriptive data are shown as mean ± standard deviation. Comparisons of categorical data used Chi Square and continuous data by student t test.

Results: We identified 202 CF patients with a CVC receiving enoxaparin (n=70) or DOAC (n=132) for prophylaxis. Of the patients who received enoxaparin, 81% received 40mg daily, and 83% of DOAC use was rivaroxaban 10mg daily. Patient demographics were similar between the groups (Table). Patients receiving a DOAC had a smaller CVC lumen diameter and had more prior catheters compared to enoxaparin patients. More patients receiving enoxaparin refused their doses compared to DOACs (59% vs. 8%; p< 0.001), as well as having an increased number of refused doses per patient (6.7±4.8 vs. 1.3±1.0; p< 0.001). There were more CVC complications in patients receiving enoxaparin vs. DOACs (17% vs. 8%; p=0.038). Only one major bleeding event occurred in a DOAC patient.

Conclusion(s): DOACs were better accepted by the patients compared to enoxaparin. DOACs also provided a reduction in catheter complications without increasing the risk of bleeding, making DOACs an alternative for CF patients.