Preview

Rational Pharmacotherapy in Cardiology

Advanced search

Efficacy and safety of the new oral anticoagulants in the treatment of venous thromboembolic complications: meta-analysis

https://doi.org/10.20996/1819-6446-2016-12-1-31-39

Full Text:

Abstract

Aim. Analysis of the efficacy and safety of the new oral anticoagulants (NOACs) in the management of venous thromboembolism (VTE).

Material and methods. This meta-analysis of randomized controlled trials (RCTs) was made in accordance with the instructions “Preferred reporting items for systematic reviews and meta-analyses (PRISMA)”.

Results. The meta-analysis included 5 RCTs. NOACs were as effective as vitamin K antagonists (VKAs) in preventing recurrent symptomatic VTE (RR=0.93; 95% CI 0.77-1.12; p=0.44). The incidence of recurrent thrombosis (RR=0.82; 95% CI 0.63-1.08; p=0.16) and deep vein thrombosis ± fatal or nonfatal pulmonary embolism (RR=1.06; 95% CI 0.81-1.40; p=0.66) was comparable in the groups of comparison. Meta-analysis of the safety of the NOACs suggested significant reduction of risk of major bleeding as compared with standard therapy (RR=0.54; 95% CI 0.42-0.69; р<0.00001). The incidence of all types of bleeding was significantly lower with NOACs (RR=0.70; 95% CI 0.51-0.95; p=0.02). All-cause mortality rate was comparable between the groups (RR=0.93; 95% CI 0.76-1.13; p=0.46).

Conclusions. NOACs are as effective as the standard therapy, at that they are much safer in VTE treatment.

About the Authors

V. I. Petrov
Volgograd State Medical University. Pavshikh Bortsov pl. 1, Volgograd, 400131 Russia
Russian Federation


O. V. Shatalova
Volgograd State Medical University. Pavshikh Bortsov pl. 1, Volgograd, 400131 Russia
Russian Federation


V. S. Gorbatenko
Volgograd State Medical University. Pavshikh Bortsov pl. 1, Volgograd, 400131 Russia
Russian Federation


O. N. Smuseva
Volgograd State Medical University. Pavshikh Bortsov pl. 1, Volgograd, 400131 Russia
Russian Federation


A. S. Maslakov
Volgograd State Medical University. Pavshikh Bortsov pl. 1, Volgograd, 400131 Russia
Russian Federation


References

1. Savelyev VS, Chazov EI, Gusev EI, et al. The Russian clinical recommendations for diagnosis, treatment and prevention of venous thromboembolic events. Flebologiia 2010; 4: 1-40. In Russian (Савельев В.С., Чазов Е.И.. Гусев Е.И. и др. Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений. Флебология 2010; 4: 1-40).

2. Heit J., Cohen A., Anderson F. et al. Estimated annual number of incident and recurrent, non-fatal and fatal venous thromboembolism (VTE) events in the US. Blood (ASH Annual Meeting Abstracts) 2005; 106: Abstract 910.

3. Cohen A., Agnelli G., Anderson F. et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007; 98: 756-64.

4. Spencer F., Emery C., Lessard D. et al. The Worcester Venous Thromboembolism study: a populationbased study of the clinical epidemiology of venous thromboembolism. J Gen Intern Med 2006; 21: 722-7.

5. Cohen A., Dobromirski M. The use of rivaroxaban for short- and long-term treatment of venous thromboembolism. Thromb Haemost 2012; 107 (6): 1035-43.

6. Guidelines on the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology, 2014

7. Kearon C., Akl E., Comerota A. et al. Antithrombotic Therapy for VTE Disease Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (Suppl 2): S419-94.

8. Ansell J., Hirsh J., Hylek E. et al. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians evidence-based clinical practice guidelines (8th ed). Chest 2008; 133: S160-98.

9. Moher D., Liberati A., Tetzlaff J., Altman D.G. The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Open Med 2009; 3: 123-30.

10. Lau J., Ioannidis J.P., Schmid C.H. Quantitative synthesis in systematic reviews. Ann Intern Med 1997; 127: 820-6.

11. Mantel N., Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959; 22: 719-48.

12. DerSimonian R., Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-88.

13. Higgins J.P., Thompson S.G. Quantifying heterogeneity in a metaanalysis. Stat Med 2002; 21: 1539- 58.

14. The EINSTEIN Investigators. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 2010;363:2499-510.

15. The EINSTEIN-PE Investigators. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med 2012;366:1287-97.

16. Schulman S, Kearon C, Kakkar AK, et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med 2009;361:2342-52.

17. Schulman S, Kakkar AK, Goldhaber SZ, et al. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation 2014;129:764-72.

18. Agnelli G., Buller H.R., Cohen A., et al. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med 2013; 369 (9): 799-808.

19. Prins MH, Lensing AW, Bauersachs R, et al. Oral rivaroxaban versus standard therapy for the treatment of symptomatic venous thromboembolism: a pooled analysis of the EINSTEIN-DVT and PE randomized studies. Thrombosis Journal 2013; 11:21.


For citation:


Petrov V.I., Shatalova O.V., Gorbatenko V.S., Smuseva O.N., Maslakov A.S. Efficacy and safety of the new oral anticoagulants in the treatment of venous thromboembolic complications: meta-analysis. Rational Pharmacotherapy in Cardiology. 2016;12(1):31-39. (In Russ.) https://doi.org/10.20996/1819-6446-2016-12-1-31-39

Views: 381


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)