Incidence of recurrent venous thromboembolism of patients after termination of treatment with ximelagatran.
OBJECTIVE
Recurrent thromboembolic events may occur after termination of anticoagulant therapy for acute venous thromboembolism (VTE) using oral direct thrombin inhibitor ximelagatran.


METHODS
Patients with VTE recruited at the German study centres were followed-up for an additional 18 months, treated initially with 2x36 mg ximelagatran daily or with enoxaparin/warfarin over 6 months (THRIVE Treatment study) and 2x24 mg ximelagatran daily or placebo over 18 months (THRIVE III study). Recurrent VTE and the combined outcome events consisting of recurrent VTE, other thrombotic complication, major bleeding and mortality were analysed.


RESULTS
In the THRIVE Treatment study, no patient suffered from a recurrent VTE, but 1 patient randomised to enoxaparin/warfarin experienced major bleeding. During follow-up, 4/32 and 3/32 patients initially randomised to ximelagatran and enoxaparin/warfarin developed recurrent VTE (p=0.7024). No major bleed occurred. One patient in each group died. The incidences of the combined outcome events were not different (p=0.9326). In the THRIVE III study, 0/9 versus 5/14 patients randomised to ximelagatran and placebo developed recurrent VTE including 1 fatal pulmonary embolism (p=0.0501). During follow-up, 3/9 and no patients initially randomised to ximelagatran and placebo developed recurrent VTE. One and 3 other outcome events occurred in patients initially randomised to ximelagatran or placebo. During follow-up, recurrent VTE (p=0.6893) and combined outcome events (p=0.3642) were not different between the groups.


CONCLUSIONS
The results of the follow-up studies suggest that thromboembolic events may re-occur in patients with acute VTE after termination of treatment with both vitamin K-antagonists and ximelagatran.
Harenberg
Job
J
IV. Department of Medicine, University Hospital Mannheim, Theodor-Kutzer-Ufer, 68167 Mannheim, Germany, J-Harenberg@t-online.de
Jörg
Ingrid
I
Weiss
Christel
C
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D001158:Arteries / Q000503:physiopathology; D001384:Azetidines / Q000008:administration & dosage / Q000627:therapeutic use*; D001596:Benzylamines / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D017984:Enoxaparin / Q000627:therapeutic use; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006470:Hemorrhage / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D019934:International Normalized Ratio; D018482:Muscle, Skeletal / Q000503:physiopathology; D011446:Prospective Studies; D012008:Recurrence; D012170:Retinal Vein Occlusion / Q000209:etiology; D013997:Time Factors; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use
D000925:Anticoagulants; D001384:Azetidines; D001596:Benzylamines; D017984:Enoxaparin; C426686:ximelagatran; D014859:Warfarin