NUR 01.3 - What are the outcomes of patients prescribed Direct Oral Anticoagulants (DOACs) for acute Venous Thromboembolism (VTE) with a Creatinine Clearance (CrCl) ≤ 30 mL/min?

Saturday, June 22, 2024

15:00 – 15:15 ICT

Room: 211 A-D

Co-Author(s)

HT

Hibah Tahir

Student Pharmacist
King's College London
London, England, United Kingdom
CT

Claire Tunstell

Senior Anticoagulation Pharmacist
King's College Hospital
London, England, United Kingdom

Presenting Author(s)

Jignesh P. Patel, PhD

Consultant Pharmacist
King's College London & King's College Hospital
London, England, United Kingdom

Co-Author(s)

Julia Czuprynska

Consultant Haematologist
King's College Hospital
London, England, United Kingdom
Lara N. Roberts

Consultant Haematologist
King's College Hospital
London, England, United Kingdom
Roopen Arya

Professor of Thrombosis and Haemostasis at King's College London
King’s Thrombosis Centre, Department of Haematological Medicine, King’s College Hospital Foundation NHS Trust, London, UK
London, England, United Kingdom

Background: DOACs are increasingly prescribed for VTE. However, the published experience with the use of DOACs is limited in patients with a CrCl ≤ 30 mL/min, as they were excluded from most of the DOAC VTE clinical trials.

Aims: To report on the 3-month outcomes of patients prescribed DOACs for acute VTE with a CrCl ≤ 30 mL/min.

Methods: This retrospective cohort study identified and reviewed the case notes of all patients diagnosed with acute VTE and a CrCl ≤ 30 mL/min at diagnosis between 01/05/2017 and 30/06/2023 at Princess Royal University Hospital, UK. Patient outcomes were evaluated and included the incidence of recurrent VTE, bleeding, and mortality at three months. Descriptive statistics were used to report the findings.

Results: A total of 135 patients were identified and reviewed. The majority of patients were elderly, with a high proportion of females (Table 1). A range of anticoagulants were prescribed with most patients prescribed either DOACs or enoxaparin. The number of patients prescribed DOACs were: apixaban (n=24, 18%), rivaroxaban (n=28, 21%), edoxaban (n=5, 3%). By 3 months, there were 2 extensions of events, 42 patients had died (31%) of which 2 were related to bleeding (both intracranial haemorrhages – one on warfarin and one on edoxaban). Of the patients prescribed DOACs, major bleeding occurred in one patient (0.74%), prescribed edoxaban (Figure 1). Clinically relevant non-major bleeding was seen in 3 patients prescribed DOACs (2.2%).

Conclusion(s): Anticoagulating patients with significant renal dysfunction is challenging. Although DOACs are a convenient option, major bleeding remains a concern. Prospective studies with larger cohorts of patients are required to determine the optimal anticoagulation VTE management option in this group of patients.