TY - JOUR
T1 - Use of Prestudy Heparin Did Not Influence the Efficacy and Safety of Rivaroxaban in Patients Treated for Symptomatic Venous Thromboembolism in the EINSTEIN DVT and EINSTEIN PE Studies
AU - Prandoni, P.
AU - Prins, M.H.
AU - Cohen, A.T.
AU - Müller, K.
AU - Pap, A.F.
AU - Tewes, M.C.
AU - Lensing, A.W.A.
PY - 2015/2
Y1 - 2015/2
N2 - Objectives: In the EINSTEIN DVT and EINSTEIN PE studies, the majority of patients received heparins to bridge the period during venous thromboembolism (VTE) diagnosis confirmation and the start of the study. In contrast to vitamin K antagonists (VKAs), rivaroxaban may not require initial heparin treatment.Methods: To evaluate the effect of prestudy heparin on the efficacy and safety of rivaroxaban relative to enoxaparin/VKA, the 3-month incidence of recurrent VTE, and the 14-day incidence of major and non-major clinically relevant bleeding were compared in patients who did and did not receive prestudy heparin.Results: Of the 8,281 patients randomized, 6,937 (83.8%) received prestudy heparin (mean +/- SD duration = rivaroxaban: 1.04 [+/- 0.74] days; enoxaparin 1.03 [+/- 0.42] days), and 1,344 (16.2%) did not. In patients who did not receive prestudy heparin, the incidences of recurrent VTE were similar in rivaroxaban (15 of 649, 2.3%) and enoxaparin/VKA (13 of 695, 1.9%) patients (adjusted hazard ratio [HR] = 1.11; 95% confidence interval [CI] = 0.52 to 2.37). The incidences of recurrent VTE were also similar in rivaroxaban (54 of 3,501, 1.5%) and enoxaparin/VKA (69 of 3,436, 2.0%) patients who did receive prestudy heparin (adjusted HR = 0.74; 95% CI = 0.52 to 1.06; pinteraction = 0.32). The incidences of major or nonmajor clinically relevant bleeding with rivaroxaban were not significantly different from those with enoxaparin/VKA, either with (105 of 3,485, 3.0% vs. 104 of 3,428, 3.0%; adjusted HR = 0.98; 95% CI = 0.75 to 1.29) or without (24 of 645, 3.7% vs. 30 of 688, 4.4%; adjusted HR = 0.81; 95% CI = 0.46 to 1.40; pinteraction = 0.68) prestudy heparin.Conclusions: Although the majority of patients in the EINSTEIN studies received prestudy heparin, there were no notable differences in treatment effect of rivaroxaban versus enoxaparin/VKA in those who did and did not receive it. (C) 2015 by the Society for Academic Emergency Medicine
AB - Objectives: In the EINSTEIN DVT and EINSTEIN PE studies, the majority of patients received heparins to bridge the period during venous thromboembolism (VTE) diagnosis confirmation and the start of the study. In contrast to vitamin K antagonists (VKAs), rivaroxaban may not require initial heparin treatment.Methods: To evaluate the effect of prestudy heparin on the efficacy and safety of rivaroxaban relative to enoxaparin/VKA, the 3-month incidence of recurrent VTE, and the 14-day incidence of major and non-major clinically relevant bleeding were compared in patients who did and did not receive prestudy heparin.Results: Of the 8,281 patients randomized, 6,937 (83.8%) received prestudy heparin (mean +/- SD duration = rivaroxaban: 1.04 [+/- 0.74] days; enoxaparin 1.03 [+/- 0.42] days), and 1,344 (16.2%) did not. In patients who did not receive prestudy heparin, the incidences of recurrent VTE were similar in rivaroxaban (15 of 649, 2.3%) and enoxaparin/VKA (13 of 695, 1.9%) patients (adjusted hazard ratio [HR] = 1.11; 95% confidence interval [CI] = 0.52 to 2.37). The incidences of recurrent VTE were also similar in rivaroxaban (54 of 3,501, 1.5%) and enoxaparin/VKA (69 of 3,436, 2.0%) patients who did receive prestudy heparin (adjusted HR = 0.74; 95% CI = 0.52 to 1.06; pinteraction = 0.32). The incidences of major or nonmajor clinically relevant bleeding with rivaroxaban were not significantly different from those with enoxaparin/VKA, either with (105 of 3,485, 3.0% vs. 104 of 3,428, 3.0%; adjusted HR = 0.98; 95% CI = 0.75 to 1.29) or without (24 of 645, 3.7% vs. 30 of 688, 4.4%; adjusted HR = 0.81; 95% CI = 0.46 to 1.40; pinteraction = 0.68) prestudy heparin.Conclusions: Although the majority of patients in the EINSTEIN studies received prestudy heparin, there were no notable differences in treatment effect of rivaroxaban versus enoxaparin/VKA in those who did and did not receive it. (C) 2015 by the Society for Academic Emergency Medicine
KW - DEEP-VEIN THROMBOSIS
KW - FACTOR-XA INHIBITOR
KW - PULMONARY-EMBOLISM
KW - OUTPATIENT TREATMENT
KW - INITIAL TREATMENT
KW - ORAL RIVAROXABAN
KW - PHARMACODYNAMICS
KW - PHARMACOKINETICS
KW - BAY-59-7939
KW - PREVENTION
U2 - 10.1111/acem.12585
DO - 10.1111/acem.12585
M3 - Article
C2 - 25676529
SN - 1069-6563
VL - 22
SP - 143
EP - 149
JO - Academic Emergency Medicine
JF - Academic Emergency Medicine
IS - 2
ER -