How effective are the new oral anticoagulants at preventing recurrence of venous thromboembolism?

Bottom line:  Compared to LMWH The new oral anticoagulants (NOACs) are safe and effective for treatment of thromboembolism.  Rivaroxaban and apixiban have lower bleeding risk compared to warfarin therapy.

Summary:  Lana A. Castellucci, et al.  Clinical and safety outcomes associated with treatment of acute venous thromboembolism: A systematic review and meta-analysis.  JAMA. 2014 Sep 17;312(11):1122-35.
This systematic review compares 45 RCTs for efficacy and safety of anticoagulant treatments for 44,989 patients with acute venous thromboembolism.  Treatments included unfractionated heparin, (UFH) plus vitamin K antagonist, fondaparinux plus vitamin K antagonist, low-molecular-weight heparin (LMWH) plus dabigatran, LMWH plus edoxaban, LMWH plus vitamin K antagonist, rivaroxaban, apixaban, and LMWH alone.
RESULTS:  See Table 5 (p. 1130) Meta-analysis (including indirect comparisons)
Recurrent VTE:  No significant differences among treatments except for risk significantly decreased with LMWH alone compared to UFH plus vitamin K antagonist (hazard ratio 0.7, 95% CI 0.5-0.95).
Risk of major bleeding:  Decreased with apixaban compared to UFH plus vitamin K antagonist, fondaparinux plus vitamin K antagonist, LMWH plus dabigatran, LMWH plus edoxaban, and LMWH plus vitamin K antagonist.  Decreased risk with rivaroxaban compared to UFH plus vitamin K antagonist and LMWH plus vitamin K antagonist.

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About Amy

Clinical Informationist at EUH Branch Library
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