SHM Converge Scientific Abstract ePoster Gallery-Thrombotic Risk With Warfarin, Dabigatran, or Enoxaparin After Doac Failure

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This retrospective chart review evaluated whether warfarin, dabigatran, or enoxaparin is more effective after failure of a direct oral anticoagulant (DOAC) in patients with acute venous thromboembolism (VTE). The study included 166 patients treated with apixaban or rivaroxaban who developed recurrent thrombosis while on anticoagulation between 2010 and 2022.<br /><br />After DOAC failure, patients were switched to warfarin (36%), dabigatran (25%), or enoxaparin (39%). The main outcomes were second recurrent thrombosis and major bleeding. Overall, 27 patients (16.3%) experienced a second recurrent thrombosis, and 17 patients (10.2%) had major bleeding. There was no significant difference in second thrombosis-free survival among the three anticoagulants (p=0.72), and no significant difference in major bleeding risk (p=0.30).<br /><br />Baseline characteristics were generally similar across groups, though the causes of recurrent thrombosis and follow-up time differed somewhat. The authors used ANOVA, chi-square testing, and Kaplan-Meier analysis to compare outcomes.<br /><br />The key conclusion is that no one second-line anticoagulant clearly outperformed the others after DOAC failure. Therefore, the choice of warfarin, dabigatran, or enoxaparin should be individualized based on patient history, cost, administration route, and monitoring considerations.<br /><br />Main limitations include the retrospective design and the fact that the number of patients in each treatment arm was relatively small.

Asset Subtitle

Margaret Shyu

Meta Tag

Author List Alison I. Gregorian, Andrew Srisuwananukorn, Angela Liu, Anya Srikureja, Douglas Tremblay, Leonard Naymagon, Margaret Shyu

Category Research

Concept Direct Oral Anticoagulant

Concept Venous Thromboembolism

Concept Anticoagulant

Concept Recurrent Thrombosis

Concept Warfarin

Distinguished Finalist

Presenter Organization Stanford University

Presenting Author Margaret Shyu

Track Other

Keywords

warfarin

dabigatran

enoxaparin

direct oral anticoagulant failure

venous thromboembolism

recurrent thrombosis

major bleeding

retrospective chart review

anticoagulation therapy

Kaplan-Meier analysis

Direct Oral Anticoagulant

Venous Thromboembolism

Anticoagulant

Recurrent Thrombosis

Warfarin