This study compared treatment of provoked deep vein thrombosis (DVT) with rivaroxaban versus vitamin K antagonists (VKA). Patients receiving rivaroxaban required significantly fewer clinic visits than those on VKA (2.92 visits versus 14.58 visits). While on VKA, over a third of patients spent less than 60% of time within the therapeutic range and significant time above or below that range. The overall drug costs were similar between the two treatments, but rivaroxaban required less outpatient attendance. The study concludes that for provoked DVT, rivaroxaban results in safer anticoagulation and less clinic visits compared to VKA.

1. ISTH 2015 Abstract Submission
Topic: Venous thromboembolism - therapy
ISTH15ABS-1684
RIVAROXABAN VERSUS VITAMIN K ANTAGONIST IN PROVOKED DEEP VENOUS THROMBOSIS - WHICH
TREATMENT IS BETTER FOR THE PATIENT ?
Emma Groarke* 1, William Courtney1, Jane Conway1, Elaine Conway1, Deborah Bourke1, Jean Saunders2, Michael Watts3
, Denis O'Keeffe1
1Department of Haematology, University Hospital Limerick, Dooradoyle, Limerick, 2Department of Maths and Statistics,
University of Limerick, Limerick, 3Department of Medicine, University Hospital Limerick, Dooradoyle, Limerick, Ireland
Preferred Presentation Method: Oral or Poster
Travel Grant Application: Young Investigator Award
I confirm fulfilling the criteria for the Young Investigator Award: Yes
Background: Deep venous thrombosis (DVT) is a common medical condition that particularly occurs associated with an
underlying provoking factor. Current guidelines recommend three months of anticoagulant therapy for all patients with a
provoked DVT. Traditionally, the agent of choice has been oral vitamin K antagonists (VKA), in combination with sub-
cutaneous low molecular weight heparin. VKA require intensive monitoring particularly during the initiation of
anticoagulation, and have a relatively narrow therapeutic window. Direct oral agents (DOACs) have recently been
licensed for the treatment of DVT.
Aims: To compare the cost, safety, and patient clinic visit requirements for rivaroxaban versus VKA.
Methods: Prospective data was collected on new patients with provoked DVT who received rivaroxaban for three months
between November 2013 and December 2014. This data was compared to an age and sex matched group of historical
patients who received a VKA in our unit before November 2013.
Results: 24 patients received rivaroxaban during the study period. This data was matched to a comparable historical
group treated in our unit. Average age was 49.8 in VKA group versus 48 in rivaroxaban group with 3:7 M/F ratio. 79% of
DVTs were below knee. No significant bleeds occurred in either group. 37.5% of patients on VKA spent less than 60% of
time in the therapeutic range. They spent an median time of 17% in supratheraputic and 15% in subtherapeutic range.
VKA patients required significantly more clinic visits. (14.58 visits versus 2.92). The overall cost to the health service per
patient for 3 months treatment was E260.68 for VKA compared to E273.30 for rivaroxaban. This does not include the
cost to the patient of multiple clinic visits.
Conclusion: For provoked DVT rivaroxaban treatment resulted in less outpatient attendance, with similar overall drug
costs to VKA, and safer anticoagulation.
Disclosure of Interest: None Declared
Keywords: Cost-effectiveness, Deep vein thrombosis, Factor Xa inhibitor, Oral anticoagulants, Vitamin K antagonist