Key result
Edoxaban cuts VTE recurrence ~50% vs VKAs, while apixaban reduces bleeding in adults over 75.
Why the study?
To evaluate the efficacy and safety of direct oral anticoagulants in adults aged 75 and over undergoing acute venous thromboembolism treatment.
Do direct oral anticoagulants reduce VTE recurrence and bleeding compared to vitamin K antagonists in adults aged 75 and older with acute venous thromboembolism?
Meta-Analysis (n=3,665)
Do direct oral anticoagulants reduce VTE recurrence and bleeding compared to vitamin K antagonists in adults aged 75 and older with acute venous thromboembolism?
Effect estimate: RR 0.50 (95% CI 0.27-0.95)
In older adults (≥75 years) with acute VTE, apixaban emerges as a favorable choice due to significantly reduced bleeding risk compared to VKAs and other DOACs while maintaining comparable efficacy.
Apixaban may be preferred over VKAs for lower bleeding in elderly acute VTE; extends DOAC evidence to adults ≥75.
OBJECTIVE: This systematic review and network meta-analysis aimed to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) in adults aged 75 and over undergoing acute venous thromboembolism (VTE) treatment. METHODS: PubMed, Embase and the CENTRAL were searched up to 25 December 2023. The incidence of VTE recurrence and bleeding events was assessed. Employing a frequentist network meta-analysis approach, interventions not directly compared could be indirectly assessed through the 95% confidence interval (CI), enhancing the interpretability of the search results. The surface under the cumulative ranking curves (SUCRA) was utilized to generate the relative ranking probabilities for each group. RESULTS: Our study, analysing 6 randomised controlled trials with 3665 patients, compares direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in adults aged 75 and over with acute venous thromboembolism. Edoxaban reduces VTE recurrence risk compared with VKAs (risk ratio [RR] .50, 95% CI 0.27 - .95), while apixaban significantly decreases bleeding risk compared with VKAs (RR .23, 95% CI 0.08 - .69), edoxaban (RR .28, 95% CI 0.09 - .86) and rivaroxaban (RR .28, 95% CI 0.09 - .86). Despite low overall evidence quality, apixaban consistently ranks highest for both efficacy and safety. Findings underscore the nuanced efficacy-safety balance in this population, emphasizing cautious interpretation due to evidence limitations. CONCLUSION: Apixaban emerges as a favourable choice for acute VTE treatment in the elderly, displaying reduced bleeding risk compared to other treatments while maintaining comparable efficacy. Future studies should explore diverse anticoagulants efficacy and safety in older populations. Additionally, clinical prediction models tailored to geriatric cohorts are crucial for guiding treatment duration decisions.
No takes yet. Share an insight, caveat, or question.
Pessôa et al. (2024) conducted a meta-analysis in Acute venous thromboembolism (n=3,665). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on VTE recurrence (RR 0.50, 95% CI 0.27-0.95). Edoxaban reduced VTE recurrence vs VKAs (RR 0.50; 95% CI 0.27-0.95), and apixaban decreased bleeding risk vs VKAs (RR 0.23; 95% CI 0.08-0.69) in adults ≥75 with acute VTE.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: