EXTENDED ANTICOAGULANT THERAPYIN PATIENTS, WHO SURVIVED PULMONARY EMBOLISM
https://doi.org/10.21518/2307-1109-2018-2-36-45
Abstract
The review article discusses the options to extend anticoagulant therapy after completing the main anticoagulant therapy course in patients, who survived pulmonary embolism. It presents the results of randomized RE-MEDY and RE-SONATE studies of dabigatran, EINSTEIN-Extension study of rivaroxaban and AMPLIFY-Extension study of apixaban, which evaluated the feasibility, efficacy and safety of extended anticoagulant therapy with direct acting oral anticoagulants compared with placebo or warfarin. The article also provides the results of ASPIRE and WARFASA studies, which evaluated the possibility of using low-dose aspirin vs. Placebo for the extended treatment. The authors reviewed in details the results of einstein choice study, in which they compared the extended therapy with two doses of rivaroxaban (10 or 20 mg once a day) versus low (100 mg/day) doses of aspirin and against each other. The data obtained indicate that both doses of rivaroxaban significantly exceed aspirin in efficacy and reduce the risk of recurrent venous thrombosis by 74 and 66 %, respectively, without significantly increasing the risk of bleeding.
About the Authors
Natalia M. Vorobieva
Federal State Budgetary Educational Institution of Higher Education «Pirogov Russian National Research Medical University», of the Ministry of Health of Russia, a separate structural subdivision – Russian Gerontological Research and Clinical Center
Russian Federation
Russian Federation
Vorobieva Natalia Mikhailovna – Dr. of sci. (Med.), senior Researcher of the Cardiovascular Aging Research Laboratory
tel.: +7 (499) 187–12–54
16 Pervaya Leonova str., 129226, MoscowElizaveta P. Panchenko
Federal State Budgetary Institution «National Medical Research Center of Cardiology» of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Panchenko Elizaveta Pavlovna – Dr. of sci. (Med), Professor, Head of Department of Clinical Problems in Atherothrombosis
tel.: +7 (495) 150–44–19
15А Tretia Cherepkovskaya str., Moscow, 121552References
1. Silverstein M. D., Heit J. A., Mohr D.N. et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Internmed. 1998; 158: 585–593.
2. Ogere. Incidence of venous thromboembolism: a community-based study in western France. Thromb Haemost. 2000; 83: 657–660.
3. Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений. Флебология. 2015; 4 (2): 3–52. [Russian clinical guidelines for the diagnosis, treatment and prevention of venous thromboembolic complications. Phlebology. 2015; 4 (2): 3–52.] (In Russ).
4. Douketis J. D., Kearon C., Bates S. et al. Risk of fatal pulmonary embolism in patients with treated venous thromboembolism. JAMA. 1998; 279: 458–462.
5. Goldhabers. Z., Bounameaux H. Pulmonary embolism and deep vein thrombosis. Lancet. 2012; 379: 1835–1846.
6. Schulman S., Kearon C., Kakkar A. K. et al. Extended use of dabigatran, warfarin, or placebo in venous thromboembolism. N Engl J Med.2013; 368: 709–718.
7. Bauersachs R., BerkoWitz S. D., Brenner B. et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010; 363: 2499–2510.
8. Agnelli G., Buller H. R., Cohen A. et al. Apixaban for extended treatment of venous thromboembolism. N Engl J Med. 2013; 368: 699–708.
9. Ridker P. M., Goldhaber S. Z., Danielsone. et al. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med. 2003; 348: 1425–1434.
10. Kearon C., Ginsberg J.S., Kovacs M. J. et al. Comparison of low-intensity warfarin therapy with conventional-intensity warfarin therapy for long-term prevention of recurrent venous thromboembolism. N Engl J med.2003; 349: 631–639.
11. Brighton T. A., Eikelboom J. W., Mann K. et al. Lowdose aspirin for preventing recurrent venous thromboembolism. N Engl J Med. 2012; 367: 1979–1987.
12. Becattini C., Agnelli G., Schenone A. et al. Aspirin for preventing the recurrence of venous thromboembolism. N Engl J Med. 2012; 366: 959–1967.
13. Weitz J. I., Lensing A. W. A., Prins M. H. et al., For the EINSTEIN CHOICE Investigators. Rivaroxaban or Aspirin for extended treatment of Venous thromboembolism. N Engl J Med. 2017; 376: 1211– 1222.
14. Spencer F. A., Gore J. M., Lessard D. et al. Patient outcomes after deep vein thrombosis and pulmonary embolism: the Worcester Venous thromboembolism study. Arch Intern Med. 2008; 168: 425–430.
Review
For citations:
Vorobieva N.M., Panchenko E.P. EXTENDED ANTICOAGULANT THERAPYIN PATIENTS, WHO SURVIVED PULMONARY EMBOLISM. Aterotromboz = Atherothrombosis. 2018;(2):36-45. (In Russ.) https://doi.org/10.21518/2307-1109-2018-2-36-45
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