Janczak DT, et al. - The intention of the authors was to contemplate the outcome of direct oral anticoagulants (DOACs), specifically Xa inhibitors: Rivaroxaban and apixaban, for the treatment of venous thromboembolism (VTE) of atypical location (VTE-AL), portal, mesenteric, hepatic, splenic, gonadal, renal, and cerebral veins. No difference was reported in the VTE recurrence and bleeding rates for rivaroxaban and apixaban used in VTE-AL and those in patients with VTE-TL. They appeared to be similar to enoxaparin.

Methods

• Researchers examined patients with acute VTE-AL treated with DOACs, recruited between March 1, 2013, and February 1, 2017.
• These patients were compared with patients with VTE of typical location (VTE-TL: deep vein thrombosis of extremities and/or pulmonary embolism) receiving DOACs and with patients with VTE-AL treated with enoxaparin.

Results

• Among the 623 patients with acute VTE receiving the study drug within 14 days of diagnosis, 63 presented with VTE-AL: 36 on DOAC, 23 on enoxaparin, and 4 on warfarin; 352 received DOAC for VTE-TL.
• The VTE-AL treated with DOAC/enoxaparin constituted splanchnic (26/22), ovarian (8/2), renal (3/5), and cerebral veins (1/1), respectively.
• It was determined that the recurrence rate (per 100 person-years) for the VTE-AL group receiving DOAC was 7.3.
• It did not vary with those for VTE-TL (2.4; P=.13) and VTE-AL groups receiving enoxaparin (23.7; P=.37).
• No variation was reported in major bleeding rate in the VTE-AL group receiving DOAC with those for VTE-TL (7.2 vs 3.0; P=.26) and VTE-AL groups on enoxaparin (22.4; P=.31).
• The findings disclosed higher mortality in the VTE-AL group on DOAC than with the VTE-TL group (21.45 [95% CI, 7.87-46.69] vs 8.26 [95% CI, 5.35, 12.20]; P=.03).
• Cancer was found in all patients with VTE-AL with events.