Jean Terrier: The Relationship Between DOAC Plasma Concentrations and Clinical Outcomes
Jean Terrier, Clinical Pharmacologist and Toxicologist at University of Rhode Island, shared a post on LinkedIn about a recent article he and his colleagues co-authored, adding:
“Should we publish neutral results?
In clinical research, positive findings often receive the most attention.
But what about studies showing no significant association?
In our recent study – ‘Relevance and limitations of clinical follow-up in a pharmacokinetic study on direct oral anticoagulants’ — conducted within the OptimAT cohort at Geneva University Hospitals, we explored the relationship between DOAC plasma concentrations (apixaban and rivaroxaban) and clinical outcomes over 2 years.
Importantly, the analysis of associations between drug exposure and clinical events was a secondary objective of the OptimAT study.
In 200 hospitalized patients, we analyzed AUC, C-max, and C-trough, and recorded ischemic, thromboembolic, and bleeding events during 2 years follow-up.
What did we observe?
We found no significant association between:
- High apixaban/rivaroxaban plasma concentrations and bleeding events
- Low apixaban/rivaroxaban plasma concentrations and ischemic/thromboembolic events
These are neutral findings – and they matter.
Of course, the study had limitations — limited statistical power due to sample size and a high rate of treatment modifications (41%) reducing the number of evaluable patients.
It is also important to highlight that larger and more recent studies have since reported clearer associations between DOAC concentrations and clinical outcomes.
Our findings do not contradict these data; they reflect the constraints of a pharmacokinetic study not primarily designed for clinical endpoint assessment.
So why publish neutral results?
Because they:
- Help reduce publication bias
- Provide a more balanced and transparent evidence base
- Contribute valuable data for future meta-analyses
- Strengthen scientific integrity and reproducibility
Science advances not only through significant results, but through complete and honest reporting.
Huge thanks to my co-author Pauline Gosselin for her outstanding work in ensuring a rigorous two-year follow-up of all patients, Christophe Combescure, Pierre Fontana, Youssef Daali, and Jean-Luc Reny, and the entire OptimAT Study Team, for their rigorous work, collaboration, and commitment to high-quality clinical research.”
Title: Relevance and limitations of clinical follow-up in a pharmacokinetic study on direct oral anticoagulants
Authors: Jean Terrier, Pauline Gosselin, Christophe Combescure, Pierre Fontana, Youssef Daali, Jean-Luc Reny
Read the Full Article on Frontiers in Pharmacology.
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