(1593) Assessment of DOAC Safety and Efficacy for Treatment of Venous Thromboembolism in Trauma Patients

Introduction: Societal guidelines do not provide recommendations for treatment of venous thromboembolism (VTE) in trauma patients. Previous studies do not adequately include trauma patients, warranting further research on direct oral anticoagulants (DOACs) in this population. The goal of this study is to compare the safety and efficacy of apixaban (APX) and rivaroxaban (RVX) for treatment of VTE in trauma patients.

Methods: A single-center retrospective study was performed on trauma patients at Temple University Hospital who received APX or RVX for VTE between August 2016 and July 2021. Patients were excluded if they had a history of prior VTE; vascular injury with associated vein ligation; known bleeding disorder; pregnant or breastfeeding; or had another indication for long-term anticoagulation therapy, dual antiplatelet therapy, or treatment with aspirin at a dose greater than 162 mg daily. Primary safety and efficacy endpoints included VTE recurrence, VTE-related death, and occurrence of major bleeding within 12 months. Data collection included patient demographics, baseline characteristics, and variables to assess recurrence of VTE and bleeding.

Results: 31 patients (18 in RVX vs. 13 in APX) were included in the study. In the RVX group, the mean age was 43 years, and majority male (78%). In the APX group, the mean age was 38 years, and majority male (85%). A majority of patients in both groups presented with blunt trauma (61% in the RVX group and 54% in the APX group). DVT was the most common VTE type in both groups (56% in the RVX group and 46% in the APX group). One patient in the APX group experienced expansion of an intracranial hemorrhage, and a progression of their VTE. One patient in the RVX group experienced a progression of their VTE. One patient in the RVX group experienced clinically significant non-major bleeding (rectal bleeding) requiring adjustment of their anticoagulation.

Conclusions: The results of this study add to the evidence suggesting the safety and efficacy of DOACs for the treatment of VTE in trauma patients. This hypothesis-generating research provides information regarding this patient population where data is limited; however, larger, randomized controlled trials are needed to confirm their place in therapy.