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

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Authors
Sobieraj, Diana M.
Coleman, Craig I.
Pasupuleti, Vinay
Deshpande, Abhishek
Kaw, Roop
Hernández, Adrian V.
Issue Date
2015-03-09
Keywords
Venous thromboembolism
Anticoagulant
Antiplatelet
Deep vein thrombosis
Pulmonary embolism

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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
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
ISSN
0049-3848
ae974a485f413a2113503eed53cd6c53
10.1016/j.thromres.2015.02.032
Scopus Count
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Medicina

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