Abstract | BACKGROUND: METHODS: To evaluate the efficacy and safety of different anticoagulants we performed a network meta-analysis of RCTs including patients with CAT treated with LMWHs, vitamin K antagonists (VKAs) or DOACs. MEDLINE and EMBASE were searched up to February 2018. The primary efficacy and safety outcomes were recurrent VTE and major bleeding, respectively. RESULTS: Overall, 4720 CAT patients from 12 studies were included: 1430 from 2 studies comparing DOACs with LMWHs, 1212 from 4 studies comparing DOACs with VKAs and 2078 from 6 studies comparing VKAs to LMWHs. Recurrent VTE occurred in 4.9% of patients receiving DOACs, 9.6% receiving VKAs and 8.4% receiving LMWHs. The network meta-analysis showed a not significant increase of recurrent VTE in patients receiving LMWHs compared to those receiving DOACs (RR 1.3, 95% CI 0.9 to 2.0). The risk of recurrent VTE was higher in patients receiving VKAs compared to LMWHs (RR 1.5, 95% CI 1.0 to 2.0) or DOACs (RR 2.0, 95% CI 1.3 to 3.0) with no heterogeneity. Major bleeding occurred in 4.9, 4.1 and 4.3% of patients with CAT treated with DOAC, VKA or LMWH, respectively. No significant differences were observed from the direct, indirect and network meta-analyses. CONCLUSION: In patients with CAT, DOACs showed a good efficacy and safety profile compared to other anticoagulants and is candidates to be an alternative to LMWHs.
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Authors | Maria Cristina Vedovati, Michela Giustozzi, Gianluca Bonitta, Giancarlo Agnelli, Cecilia Becattini |
Journal | Thrombosis research
(Thromb Res)
Vol. 170
Pg. 175-180
(10 2018)
ISSN: 1879-2472 [Electronic] United States |
PMID | 30196195
(Publication Type: Journal Article, Meta-Analysis)
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Copyright | Copyright © 2018 Elsevier Ltd. All rights reserved. |
Chemical References |
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Topics |
- Anticoagulants
(pharmacology, therapeutic use)
- Humans
- Neoplasms
(drug therapy, pathology)
- Prospective Studies
- Venous Thromboembolism
(drug therapy, pathology)
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