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    Poster Networking

    Venous Thromboembolism

    Poster Networking Session

    PB0473 - VTE outcomes in patients treated with direct oral anticoagulants and concurrent antiepileptic drugs: Data from the START2 and the RIETE

    Sunday, June 25, 2023
    18:30 – 19:30 ET
    Room: Exhibition

      Presenting Author(s)

    • Omri Cohen, MD

      Senior physician
      Sheba medical center, Tel Aviv University
      Holon, HaMerkaz, Israel

      • Co-Author(s)

    • IG

      Igor Giarretta

      Senior physician
      Department of Emergency of High-Specialty and Medical Center, ASST-Settelaghi, Varese, Italy
      Varese, Lombardia, Italy

    • LB

      Lorenza Bertú

      Data manager and statistician
      3) Department of Medicine and Surgery, University of Insubria, Varese, Italy
      Varese, Lombardia, Italy

    • Walter Ageno, MD (he/him/his)

      Professor of Medicine
      Department of Medicine and Surgery, University of Insubria, Varese, Italy
      Varese, Lombardia, Italy

    • EA

      Emilia Antonucci

      Researcher
      Fondazione Arianna
      Bologna, Emilia-Romagna, Italy

    • Orly Efros, MD, MHA (she/her/hers)

      Physician, thrombosis and hemostasis specialist
      National Hemophilia Center and Thrombosis & Hemostasis Institute, Sheba Medical Center, Israel. Sackler Faculty of Medicine, Tel Aviv University, Israel.
      Rishon Letzion, HaMerkaz, Israel

    • PM

      Pablo Javier Marchena

      Head
      Department of Internal Medicine and Emergency. Parc Sanitari Sant Joan de Déu-Hospital General
      Barcelona, Catalonia, Spain

    • RM

      Radovan Malý

      Head
      Department of Cardiovascular Medicine I. Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove. Czech Republic
      Prague, Stredocesky kraj, Czech Republic

    • LM

      Lucia Mazzolai

      Head
      Department of Angiology. Centre Hospitalier Universitaire Vaudois (CHUV). Lausanne. Switzerland.
      Lausanne, Vaud, Switzerland

    • MC

      Michela Cini

      Clinical Monitor
      Arianna Anticoagulation Foundation
      Bologna, Emilia-Romagna, Italy

    • CL

      Cristina Legnani

      Clinical Monitor
      Arianna Anticoagulation Foundation
      Bologna, Emilia-Romagna, Italy

    • LM

      Ludovica Migliaccio

      Clinical Monitor
      Arianna Anticoagulation Foundation
      Bologna, Emilia-Romagna, Italy

    • JL

      Juan José López-Núñez

      Head
      Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
      Barcelona, Catalonia, Spain

    • ST

      Sophie Testa

      Head
      Centro Emostasi e Trombosi, ASST Cremona
      Cremona, Lombardia, Italy

    • JF

      José Luis Fernández-Reyes

      Head
      Department of Internal Medicine. Complejo Hospitalario de Jaén. Jaén. Spain.
      Jaén, Andalucia, Spain

    • AT

      Alberto Tosetto, MD

      Head of hematology
      Hematology Department, San Bortolo Hospital, Vicenza, Italy.
      Vicenza, Veneto, Italy

    • AS

      Andris Skride

      Head
      Department of Cardiology. Ospedale Pauls Stradins Clinical University Hospital. Riga Stradiņš University. Riga. Latvia.
      Riga, Riga, Latvia

    • DP

      Daniela Poli

      Medical Doctor
      SOD Malattie Aterotrombotiche, Azienda Ospedaliera Universitaria Careggi
      Firenze, Toscana, Italy

    • GP

      Gualtiero Palareti

      Professor
      Arianna Foundation on Anticoagulation
      Bologna, Emilia-Romagna, Italy

    • Manuel Monreal, PhD, MD

      Senior consultant
      Universidad Catolica de Murcia
      Barcelona, Catalonia, Spain

    Background: Direct oral anticoagulants (DOACs) may be prone to drug interactions. Concomitant treatment with antiepileptic drugs (AEDs) that affect either the P-gp or CYP3A4 systems can alter serum DOACs levels and their therapeutic effect. Venous thromboembolism (VTE) outcomes in patients concurrently treated with DOACs and AEDs have not been reported to date.

    Aims: We aimed to evaluate the incidence of recurrent VTE, major bleeding, and overall mortality in patients concurrently treated with AEDs and DOACs and in patients receiving AEDs and other anticoagulant drugs.

    Methods: Data on VTE patients enrolled in the prospective RIETE (Registro Informatizado de Enfermedad TromboEmbólica) and START2 (Survey on anticoagulaTed pAtients RegisTer) registries were pooled and analyzed. Outcomes of interest were VTE recurrence, major bleeding and mortality.

    Results: Overall, 369 VTE patients from both registries were concurrently treated with AEDs and anticoagulants, 245 (66.4%) were treated with DOACs, 86 (23.3%) with VKAs and 38 (10.3%) with parenteral anticoagulants (LMWH/fondaparinux). Mean age was 66.2 ± 16.7 years, 41.6% were male (Table 1). Of DOACs treated patients, 103 (27,9%), 101 (27,4%), 32 (8,7%), and 9 (2,4%) patients were treated with rivaroxaban, apixaban, edoxaban and dabigatran, respectively.
    During a median follow-up of 8.4 (IQR 3.6-19.2) months, incidence rates of on-treatment VTE recurrence, major bleeding and mortality per 100 PY (95%CI) were 2.2 (1.0-4.8), 1.5 (0.6-3.9) and 3.6 (1.9-6.6) among patients treated with DOACs, 2.1 (0.7-6.6), 2.2 (0.7-6.7) and 5.9 (3.1-11.4) among patients treated with VKAs, and 9.3 (3.0-28.9), 8.6 (2.8-26.7) and 23.8 (12.8-44.2) among patients treated with LMWH or fondaparinux, respectively (Table 2).

    Conclusion(s): Among VTE patients concurrently treated with anticoagulants and AEDs enrolled in the RIETE and START2 registries, incidence rates of on-treatment VTE recurrence and major bleeding were comparable between patients treated with DOACs and VKAs, and worse for LMWH and fondaparinux, mostly due to underlying comorbidities.