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Oral Rivaroxaban Versus Warfarin After inferior Vena cava Filter Implantation: A Retrospective Cohort Study
Ilya Schastlivtsev1, Aleksey Pankov2, Sergey Tsaplin1,2
1Department of General Surgery, Pirogov Russian National Research Medical University, Moscow, Russia.
Insights
Rivaroxaban demonstrated comparable safety and efficacy to warfarin in patients receiving an inferior vena cava (IVC) filter. This study found no significant differences in venous thromboembolism recurrence or bleeding events between the two anticoagulants.
Area of Science:
- Cardiology
- Vascular Surgery
- Pharmacology
Background:
- Inferior vena cava (IVC) filters are used to prevent pulmonary embolism in patients with deep vein thrombosis (DVT).
- Anticoagulation is crucial after IVC filter placement, but optimal agent choice remains debated.
- Warfarin and rivaroxaban are common anticoagulants used in this setting.
Purpose of the Study:
- To compare the efficacy and safety of rivaroxaban versus warfarin in patients following IVC filter implantation.
- To evaluate outcomes related to venous thromboembolism (VTE) recurrence and bleeding events.
Main Methods:
- Retrospective analysis of 100 patients with DVT undergoing IVC filter implantation.
- Patients received either warfarin (n=41) or rivaroxaban (n=59) for 3-12 months.
- Outcomes assessed included symptomatic VTE recurrence and bleeding events at 12-month follow-up.
Main Results:
- No VTE recurrence was observed in the rivaroxaban group, compared to 7.3% in the warfarin group.
- One major bleeding event occurred with warfarin; three clinically relevant non-major bleedings occurred with rivaroxaban.
- Propensity score matching showed no significant differences in outcomes between the two groups.
Conclusions:
- Rivaroxaban appears to be a safe and effective alternative to warfarin after IVC filter implantation.
- Further prospective studies may be warranted to confirm these findings.
Objectives:
To assess the efficacy and safety of rivaroxaban compared to warfarin after inferior vena cava (IVC) filter implantation.
Method:
This retrospective analysis includes data from 100 patients with deep vein thrombosis (DVT) who underwent IVC filter implantation due to a free-floating thrombus (n = 64), thrombus propagation (n = 8), or acute bleeding (n = 8) on therapeutic anticoagulation, catheter-directed thrombolysis (n = 8), or had previously implanted filter with DVT recurrence. Patients were treated with warfarin (n = 41) or rivaroxaban (n = 59) for 3-12 months. Symptomatic venous thromboembolism (VTE) recurrence and bleeding events were assessed at 12 months follow-up.
Results:
Three (7.3%) cases of VTE recurrence without IVC filter occlusion occurred on warfarin and none on rivaroxaban. The only (2.4%) major bleeding occurred on warfarin. Three (5.1%) clinically relevant non-major bleedings were detected on rivaroxaban. No significant differences existed between groups when full and propensity scores matched datasets were compared.
Conclusions:
Rivaroxaban seems not less effective and safe than warfarin after IVC filter implantation.
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