Comparative efficacy and safety of anticoagulants and aspirin for extended treatment of venous thromboembolism: A network meta-analysis

2.50
Hdl Handle:
http://hdl.handle.net/10757/346496
Title:
Comparative efficacy and safety of anticoagulants and aspirin for extended treatment of venous thromboembolism: A network meta-analysis
Authors:
Sobieraj, Diana M.; Coleman, Craig I.; Pasupuleti, Vinay; Deshpande, Abhishek; Kaw, Roop; Hernández, Adrian V. ( 0000-0002-9999-4003 )
Citation:
1. Sobieraj DM, Coleman CI, Pasupuleti V, Deshpande A, Kaw R, Hernandez A V. Comparative efficacy and safety of anticoagulants and aspirin for extended treatment of venous thromboembolism: A network meta-analysis. Thromb Res [Internet]. Elsevier B.V.; 2015; Available from: http://linkinghub.elsevier.com/retrieve/pii/S0049384815001048
Publisher:
Elsevier B.V.
Journal:
Thrombosis Research
Issue Date:
9-Mar-2015
URI:
http://hdl.handle.net/10757/346496
DOI:
10.1016/j.thromres.2015.02.032
Additional Links:
http://www.thrombosisresearch.com/article/S0049-3848%2815%2900104-8/abstract
Abstract:
Objective To systematically review the literature and to quantitatively evaluate the efficacy and safety of extended pharmacologic treatment of venous thromboembolism (VTE) through network meta-analysis (NMA). Methods A systematic literature search (MEDLINE, Embase, Cochrane CENTRAL, through September 2014) and searching of reference lists of included studies and relevant reviews was conducted to identify randomized controlled trials of patients who completed initial anticoagulant treatment for VTE and then randomized for the extension study; compared extension of anticoagulant treatment to placebo or active control; and reported at least one outcome of interest (VTE or a composite of major bleeding or clinically relevant non-major bleeding). A random-effects Frequentist approach to NMA was used to calculate relative risks with 95% confidence intervals. Results Ten trials (n=11,079) were included. Risk of bias (assessed with the Cochrane tool) was low in most domains assessed across the included trials. Apixaban (2.5mg and 5mg), dabigatran, rivaroxaban, idraparinux and vitamin K antagonists (VKA) each significantly reduced the risk of VTE recurrence compared to placebo, ranging from a 73% reduction with idraparinux to 86% with VKAs. With exception of idraparinux, all active therapies significantly reduced VTE recurrence risk versus aspirin, ranging from a 73% reduction with either apixaban 2.5mg or rivaroxaban to 80% with VKAs. Apixaban and aspirin were the only therapies that did not increase composite bleeding risk significantly compared to placebo. All active therapies except aspirin increased risk of composite bleeding by 2 to 4-fold compared to apixaban 2.5mg, with no difference found between the two apixaban doses. Conclusion Extended treatment of VTE is a reasonable approach to provide continued protection from VTE recurrence although bleeding risk is variable across therapeutic options. Our results indicate that apixaban, dabigatran, rivaroxaban, idraparinux and VKAs all reduced VTE recurrence when compared to placebo. Apixaban appears to have a more favorable safety profile compared to other therapies.
Type:
info:eu-repo/semantics/article
Rights:
info:eu-repo/semantics/openAccess
Language:
eng
Description:
Diana.sobieraj@hhchealth.org
Keywords:
Venous thromboembolism; Anticoagulant; Antiplatelet; Deep vein thrombosis; Pulmonary embolism
ISSN:
0049-3848

Full metadata record

DC FieldValue Language
dc.contributor.authorSobieraj, Diana M.es_PE
dc.contributor.authorColeman, Craig I.es_PE
dc.contributor.authorPasupuleti, Vinayes_PE
dc.contributor.authorDeshpande, Abhishekes_PE
dc.contributor.authorKaw, Roopes_PE
dc.contributor.authorHernández, Adrian V.es_PE
dc.date.accessioned2015-03-10T20:19:07Zes_PE
dc.date.available2015-03-10T20:19:07Zes_PE
dc.date.issued2015-03-09es_PE
dc.identifier.citation1. Sobieraj DM, Coleman CI, Pasupuleti V, Deshpande A, Kaw R, Hernandez A V. Comparative efficacy and safety of anticoagulants and aspirin for extended treatment of venous thromboembolism: A network meta-analysis. Thromb Res [Internet]. Elsevier B.V.; 2015; Available from: http://linkinghub.elsevier.com/retrieve/pii/S0049384815001048es_PE
dc.identifier.issn0049-3848es_PE
dc.identifier.doi10.1016/j.thromres.2015.02.032es_PE
dc.identifier.urihttp://hdl.handle.net/10757/346496es_PE
dc.descriptionDiana.sobieraj@hhchealth.orges_PE
dc.description.abstractObjective To systematically review the literature and to quantitatively evaluate the efficacy and safety of extended pharmacologic treatment of venous thromboembolism (VTE) through network meta-analysis (NMA). Methods A systematic literature search (MEDLINE, Embase, Cochrane CENTRAL, through September 2014) and searching of reference lists of included studies and relevant reviews was conducted to identify randomized controlled trials of patients who completed initial anticoagulant treatment for VTE and then randomized for the extension study; compared extension of anticoagulant treatment to placebo or active control; and reported at least one outcome of interest (VTE or a composite of major bleeding or clinically relevant non-major bleeding). A random-effects Frequentist approach to NMA was used to calculate relative risks with 95% confidence intervals. Results Ten trials (n=11,079) were included. Risk of bias (assessed with the Cochrane tool) was low in most domains assessed across the included trials. Apixaban (2.5mg and 5mg), dabigatran, rivaroxaban, idraparinux and vitamin K antagonists (VKA) each significantly reduced the risk of VTE recurrence compared to placebo, ranging from a 73% reduction with idraparinux to 86% with VKAs. With exception of idraparinux, all active therapies significantly reduced VTE recurrence risk versus aspirin, ranging from a 73% reduction with either apixaban 2.5mg or rivaroxaban to 80% with VKAs. Apixaban and aspirin were the only therapies that did not increase composite bleeding risk significantly compared to placebo. All active therapies except aspirin increased risk of composite bleeding by 2 to 4-fold compared to apixaban 2.5mg, with no difference found between the two apixaban doses. Conclusion Extended treatment of VTE is a reasonable approach to provide continued protection from VTE recurrence although bleeding risk is variable across therapeutic options. Our results indicate that apixaban, dabigatran, rivaroxaban, idraparinux and VKAs all reduced VTE recurrence when compared to placebo. Apixaban appears to have a more favorable safety profile compared to other therapies.eng
dc.formatapplication/pdfes_PE
dc.language.isoenges_PE
dc.publisherElsevier B.V.es_PE
dc.relation.urlhttp://www.thrombosisresearch.com/article/S0049-3848%2815%2900104-8/abstractes_PE
dc.rightsinfo:eu-repo/semantics/openAccesses_PE
dc.sourceUniversidad Peruana de Ciencias Aplicadas (UPC)es_PE
dc.sourceRepositorio Académico - UPCes_PE
dc.subjectVenous thromboembolismes_PE
dc.subjectAnticoagulantes_PE
dc.subjectAntiplateletes_PE
dc.subjectDeep vein thrombosises_PE
dc.subjectPulmonary embolismes_PE
dc.titleComparative efficacy and safety of anticoagulants and aspirin for extended treatment of venous thromboembolism: A network meta-analysises_PE
dc.typeinfo:eu-repo/semantics/articlees_PE
dc.identifier.journalThrombosis Researches_PE
dc.description.peer-reviewRevisión por pareses_PE
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