Rivaroxaban versus standard anticoagulation for the treatment of pulmonary embolism: a real-life study

Introduction: In randomized controlled trials, direct oral anticoagulants are at least as effective and probably safer than standard anticoagulation in patients with venous thromboembolism (VTE). Real-life studies are of particular interest for the assessment of their efficacy and safety in unselected patients. Methods: We conducted a retrospective analysis of a prospective monocentric cohort including patients with symptomatic pulmonary embolism (PE) treated with VKA or rivaroxaban (riva) with a 6-month follow-up. We distinguished 2 periods: P1 (2010-2013) when only VKA was available; P2 (2014-2017) when VKA and riva were available. The primary outcome was the composite of all-cause mortality, major or clinically significant bleeding and symptomatic recurrent VTE under treatment. Outcomes and length of stay (LOS) were compared between riva and VKA groups using a propensity score analysis. Results: 706 patients were analysed: 271 during P1, 435 during P2 (VKA: n=143, Riva: n=292). No difference in the primary outcome was observed between P1 and P2 (respectively 8,1% vs 4,8%, p=0.1045). LOS was significantly reduced during P2 (5 [3,7] vs 6 days [4,10], p During P2, compared to VKA, patients treated with riva were younger (65 [49,75] vs 71 years [53,82], p=0.0044) and the proportion of patients with comorbidities was lower. In the propensity score adjustment sample, the primary outcome (OR 2.91 [95%CI, 1.03-8.26], p=0.044) was significantly higher in the VKA group compared to the riva group. LOS was significantly reduced in the riva group (4 vs 7 days, p Conclusion: Riva appears to be effective and safe to treat PE in a non-selected population with a shorter LOS.