Incidence of residual perfusion defects by lung scintigraphy in patients treated with rivaroxaban compared with warfarin for acute pulmonary embolism
- Resource Type
- Authors
- Ming Sheng Lim; Ian Jong; Anita Cummins; Dee Nandurkar; Huyen Tran; Sanjeev Chunilal
- Source
- Journal of Thrombosis and Thrombolysis. 49:220-227
- Subject
- Adult
Male
medicine.medical_specialty
Perfusion Imaging
030204 cardiovascular system & hematology
Scintigraphy
Gastroenterology
Ventilation/perfusion ratio
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Rivaroxaban
Internal medicine
medicine
Humans
030212 general & internal medicine
Radionuclide Imaging
Lung
Aged
Retrospective Studies
medicine.diagnostic_test
business.industry
Ventilation/perfusion scan
Incidence
Warfarin
Anticoagulants
Retrospective cohort study
Hematology
Middle Aged
medicine.disease
Pulmonary embolism
Treatment Outcome
Acute Disease
Cohort
Female
Pulmonary Embolism
Cardiology and Cardiovascular Medicine
business
Factor Xa Inhibitors
Follow-Up Studies
medicine.drug
- Language
- ISSN
- 1573-742X
0929-5305
Residual perfusion defects (RPD) as detected by lung scintigraphy occur in over 50% of patients with acute pulmonary embolism (PE) treated with vitamin K antagonists but there is lack of data in patients treated with direct oral anticoagulants. The aim of this retrospective study was to estimate the incidence of RPD detected by ventilation perfusion (VQ) scan at 3-6 months in patients with first acute symptomatic PE treated with rivaroxaban compared to warfarin. Consecutive eligible patients treated with rivaroxaban as part of a previous study were identified. The Monash Health Radiology database was used to identify a historical cohort of age matched (± 5 years) patients treated with warfarin. Follow-up VQ scans were classified as normal (no perfusion defect) or abnormal (matched or unmatched perfusion defects) by two independent nuclear medicine physicians blinded to treatment. Any disagreement was resolved by consensus. One hundred and ninety patients with PE (95 in each cohort) were included (mean age 56.8 years; 41.1% males; 54.2% unprovoked). In the overall cohort, 31.1% had RPD with a significantly lower incidence of RPD in rivaroxaban treated patients 23.2% (95% CI 15.8-32.6), compared to warfarin 38.9% (95% CI 29.8-49.0). Treatment with rivaroxaban was associated with a significantly lower incidence of RPD detected by VQ scan at 3-6 months compared to warfarin. This supports recent in-vitro data suggesting an indirect enhancement of fibrinolysis by direct oral Xa inhibitors but requires confirmation in larger studies.