1
|
Tijani A, Coons EM, Mizuki B, Dermady M, Stanilova K, Casey AL, Alqudsi M, Gastanaduy M, Elmayan A, Bamnolker A, Velez JCQ. Direct Oral Anticoagulants Versus Warfarin for Venous Thromboembolism Prophylaxis in Patients With Nephrotic Syndrome: A Retrospective Cohort Study. Ann Pharmacother 2022:10600280221129348. [DOI: 10.1177/10600280221129348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Evidence supporting venous thromboembolism (VTE) prophylaxis with direct oral anticoagulants (DOACs) in patients with nephrotic syndrome (NS) is limited to case reports. Objective: The purpose of this study was to compare bleeding and thromboembolic events in this population. Methods: A retrospective cohort study was conducted in adults with NS initiated on a DOAC or warfarin for VTE prophylaxis between January 2013 and July 2021 within the Ochsner Health System. Patients with study drug exposure within the preceding 7 days, acute VTE within the preceding 6 months, or ≤7 days of study drug exposure were excluded. The primary outcome was the composite rate of major bleeding and clinically relevant nonmajor bleeding. Secondary outcomes included time to major bleeding and rate of new thromboembolic events. This study was approved by the Ochsner Health System Institutional Review Board. Results: Twenty-five DOAC and 19 warfarin patients were included. The primary outcome occurred in 8% vs 26.3% ( P = 0.21) of patients treated with a DOAC or warfarin, respectively, and was driven by major bleeding (4% vs 21%, P = 0.25). Other secondary outcomes were similar between cohorts. The study was limited by a small sample size. Conclusion and Relevance: Use of DOACs for VTE prophylaxis resulted in a nonstatistically significant, but clinically relevant lower rate of major bleeding compared to warfarin. This study provides comparative data showing safe and effective use of DOACs in patients with NS. Prospective, randomized studies are needed to confirm results.
Collapse
Affiliation(s)
- Aminat Tijani
- Department of Pharmacy, Ochsner Health, New Orleans, LA, USA
| | - Eric M. Coons
- Department of Pharmacy, Ochsner Health, New Orleans, LA, USA
| | - Britta Mizuki
- Department of Pharmacy, Ochsner Health, New Orleans, LA, USA
| | - Miranda Dermady
- Department of Pharmacy, Ochsner Health, New Orleans, LA, USA
| | | | - Ashley L. Casey
- Department of Pharmacy, Ochsner Health, New Orleans, LA, USA
| | | | | | - Ardem Elmayan
- Ochsner Center for Outcomes Research, Ochsner Health, New Orleans, LA, USA
| | - Adi Bamnolker
- Department of Hospital Medicine, Ochsner Health, New Orleans, LA, USA
| | | |
Collapse
|