When a patient on antiplatelet drugs for primary or secondary prevention of cardiovascular events develops a venous thromboembolic (VTE) episode, a conventional anticoagulation with old or novel antithrombotic agents becomes paramount. In such circumstances, clinicians are confronted with the challenge of combining anticoagulation with antiplatelet drugs, a combination that in carriers of atrial fibrillation has consistently been shown to be hazardous [1,2]. While it would be important to know whether this is also true in patients with VTE, there are data in favor and against an increase in the bleeding risk coming from treatment combination [3,4].

The authors regret the inconvenience, but there is an error in the affiliation data of Patricia Beroiz MD, and the “Universidad Autónoma de Barcelona” is missing in her data. The correct affiliation data of Dra Beroiz is: Patricia BEROIZ, MD. Department of Geriatrics. Hospital Germans Trias i Pujol. Badalona, Barcelona. Universidad Autónoma de Barcelona. Spain. The authors would like to apologise for any inconvenience caused. Rivaroxaban or apixaban in fragile patients with acute venous thromboembolismThrombosis ResearchVol. 193PreviewThe efficacy and safety of the direct oral anticoagulants (DOACs) in fragile patients (age ≥ 75 years and/or creatinine clearance [CrCl] levels ≤50 mL/min and/or body weight ≤50kg) with venous thromboembolism (VTE) have not been consistently compared. Full-Text PDF

Introduction: The efficacy and safety of the direct oral anticoagulants (DOACs) in fragile patients (age >= 75 years and/or creatinine clearance [CrCl] levels <= 50 mL/min and/or body weight <= 50kg) with venous thromboembolism (VTE) have not been consistently compared. Material and metkods: We used the RIETE database to compare the rates of the composite of VTE recurrences or major bleeding during anticoagulation in fragile patients with VTE, according to the use of rivaroxaban or apixaban for initial and long-term therapy. Results: From January 2013 to October 2019, 36,889 patients were recruited, of whom 14,831 (40%) were fragile. Overall, 999 fragile patients (15%) received DOACs starting within the first 48 h: rivaroxaban 711 and apixaban 288. Median duration of therapy was: 113 vs. 111 days. A substantial amount of patients in both subgroups (25% vs. 40%) received non-recommended doses of DOACs. During anticoagulation, 13 patients developed VTE recurrences, 18 had major bleeding and 36 died. When only considering patients receiving recommended doses (n = 705), there were no differences between drugs in the rate of the composite outcome (rate ratio [RR]: 1.08; 95%CI: 0.35-3.30) or all-cause death (RR: 0.99; 95%CI: 0.32-3.08). On multivariable analysis, patients receiving rivaroxaban or apixaban at recommended doses had a similar risk for the composite outcome (hazard ratio: 1.34; 95%CI: 0.35-5.06). Conclusion: The use of rivaroxaban or apixaban at recommended doses in fragile patients with VTE was associated with a similar risk for VTE recurrences or major bleeding.

Background There is lack of evidence to guide the type, intensity, and the duration of anticoagulation following venous thromboembolism (VTE) in patients with inflammatory bowel disease (IBD). Patients and methods Registro Informatizado Enfermedad Trombo Embólica (RIETE) is an ongoing, multicenter, observational registry of consecutive patients with symptomatic, objectively confirmed, acute VTE. We used the RIETE database to compare the rate of VTE recurrences and major bleeding during the course of anticoagulation in noncancer patients with or without IBD. Results As of October 2014, 41 927 patients without active cancer have been recruited in RIETE. Of these, 265 (0.63%) had IBD and 85 (32%) had the VTE during an acute flare. The duration of anticoagulation was similar in patients with VTE during an acute flare (8.3±8.8 months), in remission (9.4±11.5 months), or without IBD (10.0±12.8 months). The rate of VTE recurrences [7.25, 95% confidence interval (CI): 1.46–21.2; 8.84, 95% CI: 3.23–19.2; and 5.85, 95% CI: 5.46–6.26 per 100 patient-years, respectively] and major bleeding (7.25, 95% CI: 1.46–21.2; 2.95, 95% CI: 0.33–10.6; and 4.79, 95% CI: 4.44–5.15, respectively) were similar in all three subgroups. Propensity score matching analysis confirmed the absence of differences in the rate of VTE recurrences (rate ratio: 1.16, 95% CI: 0.54–2.47) or major bleeding (rate ratio: 0.84, 95% CI: 0.31–2.23) between patients with or without IBD. Conclusion Therapeutic anticoagulation for patients with IBD and VTE is as safe and effective as for those with VTE without IBD.

BACKGROUND:Patients with chronic obstructive pulmonary disease (COPD) have a modified clinical presentation of venous thromboembolism (VTE) but also a worse prognosis than non-COPD patients with VTE. As it may induce therapeutic modifications, we evaluated the influence of the initial VTE presentation on the 3-month outcomes in COPD patients.METHODS:COPD patients included in the on-going world-wide RIETE Registry were studied. The rate of pulmonary embolism (PE), major bleeding and death during the first 3 months in COPD patients were compared according to their initial clinical presentation (acute PE or deep vein thrombosis (DVT)).RESULTS:Of the 4036 COPD patients included, 2452 (61%; 95% CI: 59.2-62.3) initially presented with PE. PE as the first VTE recurrence occurred in 116 patients, major bleeding in 101 patients and mortality in 443 patients (Fatal PE: first cause of death). Multivariate analysis confirmed that presenting with PE was associated with higher risk of VTE recurrence as PE (OR, 2.04; 95% CI: 1.11-3.72) and higher risk of fatal PE (OR, 7.77; 95% CI: 2.92-15.7).CONCLUSIONS:COPD patients presenting with PE have an increased risk for PE recurrences and fatal PE compared with those presenting with DVT alone. More efficient therapy is needed in this subtype of patients.

The publisher regrets an error in the name of the author José Manuel Casas. This error has been corrected in the above author list. The publisher would like to apologise for any inconvenience caused.

Current guidelines from the American College of Chest Physicians, based on evidence from clinical trials, recommend that patients with venous thromboembolism (VTE) be treated initially with heparin, followed by long-term treatment with a vitamin K antagonist (VKA) [1]. However, patients with active cancer are often excluded from clinical trials of anticoagulant therapy because of short life expectancy, inability or unwillingness to attend for regular laboratory monitoring during VKA therapy, or contraindications to therapy, which means that treatment regimens based on the results from clinical trials might not be suitable for many VTE patients with cancer.