Evidence map›Paper›PMID 40848117›Full record

ArticleInternational journal of clinical pharmacy2025

Does direct oral anticoagulant lead-in dosing following initial parenteral therapy affect clinical outcomes in acute venous thromboembolism?: A retrospective cohort study.

James Kim, Kiyan Heybati, Emily Thompson, Somanshu Sharma, Drew Barron, Hannah Reynolds, Maryann Mirzakandov, Kate Norville, Jenna Reynolds, Harn J Shiue

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Article in International journal of clinical pharmacy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Reduced Versus Full Lead-In Apixaban or Rivaroxaban in Acute Venous Thromboembolism: A Systematic Review.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
    Pooled it
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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

James KimDepartment of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA.
Kiyan HeybatiDepartment of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Emily ThompsonDivision of Clinical Trials & Biostatistics, Mayo Clinic, Phoenix, AZ, USA.
Somanshu SharmaAlix School of Medicine, Mayo Clinic, Phoenix, AZ, USA.
Drew BarronAlix School of Medicine, Mayo Clinic, Phoenix, AZ, USA.
Hannah ReynoldsDepartment of Pharmacy, Mayo Clinic, Phoenix, AZ, USA.
Maryann MirzakandovSchool of Health Sciences, Mayo Clinic, Phoenix, AZ, USA.
Kate NorvilleDepartment of Pharmacy, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
Jenna ReynoldsDepartment of Pharmacy, Mayo Clinic, Phoenix, AZ, USA.
Harn J ShiueDepartment of Pharmacy, Mayo Clinic, Phoenix, AZ, USA. shiue.harn@mayo.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionInitiation of direct oral anticoagulants (DOAC) for the management of venous thromboembolism (VTE) typically includes a lead-in dosing phase. However, some patients may receive a shortened course due to comorbid conditions and/or numerous days of parenteral therapy. Limited data exist on the outcomes of an abbreviated lead-in therapy regimen.

aimTo investigate the clinical outcomes of patients receiving abbreviated versus standard/non-abbreviated DOAC lead-in regimens following parenteral anticoagulation therapy for VTE.

methodWe conducted a retrospective cohort study including adults (≥ 18 years of age) who were admitted for acute VTE between 04/01/2019 and 12/31/2023 and received ≥ 24 h of parenteral anticoagulation before being transitioned to a DOAC with abbreviated versus non-abbreviated DOAC lead-in dose. The primary outcome was death or readmission from a thrombotic event within 30 days of discharge. Data were presented using descriptive statistics, logistic regression, and time-to-event analysis.

resultsAcross 590 patients, the median (IQR) age was 67 (58-76) years and 280 (47.5%) were female. Over half had a pulmonary embolism (54.9%; N = 324), 21.0% (N = 124) had a deep vein thrombosis, and the remainder experienced a combination. Most patients received the non-abbreviated lead-in dose (83.2%; N = 491). When compared to the non-abbreviated cohort, a higher proportion of those who received an abbreviated lead-in therapy had prior VTE and heart failure. There were no significant associations between an abbreviated lead-in dose and the primary outcome (aOR 0.44; 95% CI 0.13-1.52; P = 0.20). Bleeding events were also similar between the abbreviated and non-abbreviated dose cohorts at the longest follow-up (3.0%, N = 3 vs. 2.9%, N = 14; P = 0.92; aOR 0.82; 95% CI 0.22-3.1; P = 0.77) and within 30 days of DOAC initiation (HR 1.24; 95% CI 0.26-5.82; P = 0.79).

conclusionAn abbreviated DOAC lead-in therapy was not associated with short-term mortality, readmission due to recurrent thrombosis, or bleeding. Further prospective studies are needed to confirm these findings and provide insights into more personalized regimens.

Indexed as

AnticoagulantsFactor Xa InhibitorsVenous ThromboembolismAcute DiseaseAdministration, OralAgedCohort StudiesDose-Response Relationship, DrugFemaleHumansMaleMiddle AgedRetrospective StudiesTreatment OutcomeAnticoagulantsFactor Xa InhibitorsAdverse eventsApixabanOral anticoagulantsOutcomesRivaroxabanThromboembolism

Identifiers

PMID40848117

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.