Reducing doses of oral anticoagulants may improve outcomes for some patients, according to a new study.
US researchers say their findings back guidance which suggests there may be some patients who benefit if the standard dosage is reduced after six months of treatment.
The researchers at the University of Michigan say that reduced doses reduced risk of bleeding events and need for hospital visits. They point to other studies which have found that reducing the dose after six months does not increase the risk of recurrent venous thromboembolism.
The findings were reported to the conference of the American Society of Hematology last month. US guidelines in 2021 advised reducing doses, but also stated this position was based on “very low certainty evidence”.
In the current study, the researchers examined outcomes for nearly 1,000 patients being treated with apixaban or rivaroxaban in Michigan, USA. Some were given reduced ‘prophylactic’ doses after six months while others continued a full ‘therapeutic’ dose.
The team found no difference in the rate of recurrent venous thromboembolism between patients received therapeutic- and prophylactic-dose blood thinners. However, they found that those receiving the therapeutic dose had an increased rate of bleeding, and higher levels of healthcare utilisation, compared to those on the prophylactic dose.
Researcher Dr Geoffrey Barnes, of the University of Michigan Medical School, said: “In the absence of randomized trial data, these results provide the best supporting evidence that we can safely reduce the dose of direct oral anticoagulants in many patients to prevent recurrent venous thromboembolism and avoid bleeding complications.”
Fellow researcher Dr Jordan Schaefer said: “While previous studies have shown that rates of recurrent venous thromboembolism did not change when the direct oral anticoagulant dose was reduced after six months, our results suggest a higher risk of bleeding events and health care utilisation for patients continuing therapeutic dosing. This raises a question if dose reduction could be beneficial for some patients.”
Source:
Schaefer JK, Errickson J, Kong X, Callahan C, Giuliano C, Ali MA, Chipalkatti N, Haymart B, Kaatz S, Krol GD, Ryan N, Sood SL, Froehlich J, Barnes GD. (2024) “Treatment Versus Prophylactic Apixaban or Rivaroxaban for Extended Venous Thromboembolic Disease Management”. Presentatation #699 at the American Society of Hematology Annual Meeting, Sunday 8th December 2024.
Link: https://ash.confex.com/ash/2024/webprogram/Paper197878.html
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