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Follow-up management of patients receiving direct oral anticoagulants

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Abstract

Over the last years, direct oral anticoagulants (DOACs) have radically changed and simplified the therapeutic approach and management of patients on anticoagulant therapy. For these patients, international guidelines recommend to set up a regular follow-up (every 1–6 months) to re-enforce education, to ensure adequate adherence and persistence to treatment. In real-life setting, the application of the suggested follow-up regimens and incidence rates of thrombotic and bleeding complications related to the intensity of follow-up strategies has not been described. We conducted a multicentre, retrospective study at 4 Italian Thrombosis Centres to describe follow-up strategies of patients on DOACs treatment and to assess the incidence of bleeding and thrombotic complications. We enrolled 534 patients, with median follow-up 24 months: 52.1% had < 3 visits/year (group 1), while 47.9% required ≥ 3 visits/year (group 2). Mean age and gender were similar between the 2 groups, while severe anaemia (4.4% and 1.2%, p 0.03) and creatinine clearance < 50 mL/min were more common in group 2 (26.8% and 17.8%, p 0.02). The incidence of thromboembolic events was 3.9% in group 2 and 1.1% in group 1 (p 0.03). Major bleeding rates were non-significantly higher in group 2, whereas non-major bleeding rates occurred significantly more frequently in group 2 (26.6% and 18.7%, respectively, p 0.03). A tailored follow-up program is of critical importance to correctly manage patients on DOACs. A less intense follow-up management is feasible and safe for a substantial proportion of patients, provided they are carefully identified at specialized centres.

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Authors and Affiliations

  1. Department of Medicine, Maggiore Hospital, Bologna, Italy

    Chiara Fantoni

  2. Department of Clinical Medicine, University of Insubria, Varese, Italy

    Lorenza Bertù & Walter Ageno

  3. Internal Medicine Department, San Valentino Hospital, Montebelluna, Treviso, Italy

    Silvia Galliazzo

  4. A. Gemelli University Hospital IRCCS, Rome, Italy

    Roberto Pola & Angelo Porfidia

  5. Internal Medicine Department, S. Lazzaro Hospital, Alba, Italy

    Fulvio Pomero

  6. Department of Medical, Oral and Biotechnological Sciences “G. D’Annunzio” University, Chieti, Italy

    Ettore Porreca & Emanuele Valeriani

Authors
  1. Chiara Fantoni
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  2. Lorenza Bertù
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  3. Silvia Galliazzo
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  4. Roberto Pola
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  5. Fulvio Pomero
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  6. Angelo Porfidia
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  7. Ettore Porreca
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  8. Emanuele Valeriani
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  9. Walter Ageno
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Corresponding author

Correspondence to Chiara Fantoni.

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Conflict of interest

Walter Ageno received honoraria from Boehringer Ingelheim, Bayer Pharmaceuticals, BMS-Pfizer, Daiichi-Sankyo, Portola, Aspen, Sanofi and research support from Bayer Pharmaceuticals, outside the submitted work. The authors report no other conflicts of interest in this work. 

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 The study is consistent with the principles of the Declaration of Helsinki of clinical research involving human subjects.

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Due to the retrospective nature of the study, an informed consent was waived.

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Fantoni, C., Bertù, L., Galliazzo, S. et al. Follow-up management of patients receiving direct oral anticoagulants. Intern Emerg Med 16, 571–580 (2021). https://doi.org/10.1007/s11739-020-02433-w

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  • DOI: https://doi.org/10.1007/s11739-020-02433-w

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