Reduced-dose direct oral anticoagulants for extended VTE treatment resulted in similar recurrent VTE rates and lower major bleeding risk compared to standard-dose.
Do reduced-dose DOACs prevent recurrent VTE with less bleeding compared to standard-dose DOACs in patients requiring extended VTE treatment?
For extended VTE treatment, reduced-dose DOACs provide similar efficacy for preventing recurrent VTE while significantly reducing the risk of major and clinically relevant non-major bleeding compared to standard-dose DOACs.
Tasa de eventos absoluta: 0% vs 0%
Introduction:Reduced-dose direct oral anticoagulants (DOACs) may provide similar efficacy with less bleeding than standard-dose for extended venous thromboembolism (VTE) treatment. It is unclear whether standard-dose are preferable in certain subgroups. Methods:We systematically searched MEDLINE, EMBASE, EMCARE, and CENTRAL for randomized trials comparing reduced- with standard-dose DOACs for extended VTE treatment.(INPLASY202550061) Outcomes included recurrent VTE, major bleeding, clinically relevant non-major bleeding (CRNMB), and mortality. Results: Five trials (8,781 patients) were included. Reduced-dose DOACs (apixaban 2.5mg twice daily or rivaroxaban 10mg once daily, n=4,395), compared to standard-dose (apixaban 5mg twice daily or rivaroxaban 20mg once daily, n=4,386), resulted in similar rates of recurrent VTE (1.66% vs 1.78%; risk ratio RR 0.94, 95% confidence interval CI 0.68–1.29). Major bleeding was less frequent with reduced-dose (1.16% vs 1.96%; RR 0.62, 95% CI 0.42–0.92), as was CRNMB (5.16% vs 7.00%; RR 0.75, 95% CI 0.63–0.88). Mortality rates were comparable (4.91% vs 5.81%; RR 0.86, 95% CI 0.63–1.17). These results held for high-risk subgroups, including patients with recurrent VTE or active cancer, except that reduced-dose DOACs appeared to lower recurrent VTE risk in males but increase risk in females (p=0.04). Risk of bias was rated “low” in four studies and “some concerns” in one study. Certainty of evidence was moderate for three outcomes and low for one outcome. Conclusion:For extended VTE treatment, reduced-dose DOACs have a similar risk of recurrent VTE and a lower risk of major and CRNMB compared to standard-dose, including in high-risk patients. A potential interaction with sex warrants further investigation
Cheung et al. (Fri,) reported a other. Reduced-dose direct oral anticoagulants for extended VTE treatment resulted in similar recurrent VTE rates and lower major bleeding risk compared to standard-dose.