Anticoagulant Selection for Patients with VTE—Evidence from A Systematic Literature Review of Network Meta-analyses

Publication date: Available online 21 March 2019Source: Pharmacological ResearchAuthor(s): Alexander T. Cohen, Samantha E. Berger, Dušan Milenković, Nathan R. Hill, Steven ListerAbstractThe aim of this study was to systematically review published network meta-analyses (NMAs) that compare venous thromboembolism (VTE) treatments.A systematic literature search (in MEDLINE, Embase, and Cochrane Database of Systematic Reviews through September 2017) was conducted to identify NMAs that compared the safety and efficacy of direct oral anticoagulants (DOACs) for the treatment of VTE in the acute and extended treatment settings. The NMAs included randomized controlled trials comparing multiple DOACs, low-molecular weight heparin, unfractionated heparin, and vitamin K antagonists (VKAs). The quality of the NMA results were evaluated using the Grading of Recommendations and Evaluation (GRADE) assessment.The SLR identified 294 records and nine NMAs (68 trials). Among the NMAs, three evaluated the acute treatment setting, five the extended, and one in both treatment settings. The NMAs showed a significant reduction in major bleeding and clinically relevant bleeding (CRB) with apixaban compared to other DOACs. Major bleeding with apixaban was reduced compared to dabigatran, edoxaban, and fondaparinux-VKA combination in all comparisons in the acute setting (range of effect estimates: 0.30–0.43). CRB was reduced with apixaban compared to dabigatran, edoxaban, and rivaroxaban in the acute ...
Source: Pharmacological Research - Category: Drugs & Pharmacology Source Type: research