The effect of off-label use of reduced-dose direct oral anticoagulants therapy in the treatment of pulmonary embolism comparable to standard-dose therapy

• Published in: Heart and vessels 2024-04, Vol.39 (4), p.365-372
• Main Authors: Yamazoe, Shinji, Imai, Hajime, Ogawa, Yasuhiro, Kano, Naoaki, Murase, Yosuke, Mamiya, Keita, Ikeda, Tomoyo, Hiramatsu, Kei, Torii, Jun, Kawaguchi, Katsuhiro
• Format: Article
• Language: English
• Subjects: Administration, Oral; Anticoagulants; Atrial Fibrillation - drug therapy; Biomedical Engineering and Bioengineering; Cardiac Surgery; Cardiology; Computed tomography; Effectiveness; Embolism; Hemorrhage - chemically induced; Humans; Medicine; Medicine & Public Health; Observational studies; Off-Label Use; Original Article; Pulmonary Embolism - diagnosis; Pulmonary Embolism - drug therapy; Pulmonary embolisms; Reduction; Retrospective Studies; Safety; Stroke - prevention & control; Vascular Surgery
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-023-02339-5

Direct oral anticoagulants (DOACs) have been shown to be effective and safe in preventing pulmonary embolism recurrence. In this single-center retrospective observational study, we aimed to evaluate the efficacy and safety of reduced-dose DOACs in 86 consecutive patients with acute pulmonary embolism. Patients were divided into standard-dose and reduced-dose DOACs groups. Initial clot volume did not significantly differ between the two groups (standard-dose DOACs vs. reduced-dose DOACs, 18.8 [Q1–Q3 7.3–30.8] mL vs. 10.0 [Q1–Q3 3.2–27.9] mL, p = 0.1). Follow-up computed tomography (CT) within 30 days showed a higher rate of clot volume reduction or disappearance in the standard-dose group compared to the reduced-dose group (standard-dose DOACs vs. reduced-dose DOACs, 81.6% vs. 53.9%, p = 0.02). However, at the final follow-up CT, there was no significant difference in clot volume change between the two groups (standard-dose DOACs vs. reduced-dose DOACs, 91.5% vs. 82.0%, p = 0.19). Major bleeding occurred in two patients in the standard-dose group (4.3%) and three patients in the reduced-dose DOACs group (7.7%) (p = 0.5). In conclusion, while standard-dose DOACs demonstrated superior efficacy in early clot reduction, reduced doses of apixaban and edoxaban showed comparable efficacy and safety profiles in long-term treatment of acute pulmonary embolism in certain patients.