Key result
Edoxaban and rivaroxaban cut post-thrombotic syndrome risk up to ~58% versus warfarin.
Why the study?
Postthrombotic syndrome significantly affects quality of life after deep venous thrombosis, and anticoagulants have shown potential to reduce its occurrence and alleviate symptoms.
Do specific anticoagulants (such as edoxaban or rivaroxaban) reduce the incidence of post-thrombotic syndrome compared to warfarin in patients after deep venous thrombosis?
Meta-Analysis
Do specific anticoagulants (such as edoxaban or rivaroxaban) reduce the incidence of post-thrombotic syndrome compared to warfarin in patients after deep venous thrombosis?
Effect estimate: OR 0.42 (95% CI 0.18-1.0)
In a network meta-analysis, edoxaban and rivaroxaban demonstrated superior efficacy compared to warfarin in preventing post-thrombotic syndrome following deep venous thrombosis.
Supports preferring edoxaban or rivaroxaban over warfarin post-DVT to reduce PTS; reinforces network meta-analysis evidence.
BACKGROUND: Postthrombotic syndrome (PTS) has a major impact on the quality of life after deep venous thrombosis (DVT). From clinical practice and related trials, anticoagulants show potential for reducing the occurrence and alleviating the symptoms of PTS. METHODS: A systematic review and Bayesian network meta-analysis (NMA) were conducted by combing the literature from the databases of MEDLINE, Embase, Web of Science, Cochrane Libraries, and ClinicalTrials, through a variety of medical subject headings (Mesh) and PTS keywords. With regard to PTS prophylaxis, all anticoagulant-related randomized controlled trials (RCTs) and observational studies were assessed. The network model was conducted through the R software, and further comparisons were conducted using the Bayesian hierarchical random effects model. The odds ratio (OR) and the corresponding 95% CI were calculated for analysis. RESULTS: Data from two RCTs and nine non-randomized studies meeting the selection criteria were included in the Bayesian analysis model, which incorporated seven anticoagulants. Edoxaban (OR: 0.42, 95% CI: 0.18-1.0) and rivaroxaban (OR: 0.54, 95% CI: 0.38-0.76) were significantly more effective than warfarin in the prevention of PTS (Villalta score ≥ 5). A subgroup analysis based on the severity of PTS showed that rivaroxaban was more effective than warfarin, with OR: 0.59, 95% CI: 0.41-0.84 (Villalta score 5 to 14) and OR: 0.48, 95% CI: 0.22-0.9 (Villalta score ≥ 15, ulceration), respectively. Edoxaban had the highest probability (80.1%) of providing preventive benefits for PTS. For mild/moderate and severe PTS, rivaroxaban provided the highest benefits in preventing PTS (89.3% and 85.6%, respectively). CONCLUSION: Edoxaban demonstrated a better prophylactic effect on PTS (Villalta score > 5), while rivaroxaban displayed a better effect against mild/moderate (Villalta score 5 to 14) and severe PTS (Villalta score ≥ 15, ulceration).
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Shao et al. (2023) conducted a meta-analysis in Post-Thrombotic Syndrome after Deep Venous Thrombosis. Edoxaban and Rivaroxaban vs. Warfarin was evaluated on Prevention of PTS (Villalta score ≥ 5) (OR 0.42, 95% CI 0.18-1.0). Edoxaban (OR 0.42; 95% CI 0.18-1.0) and rivaroxaban (OR 0.54; 95% CI 0.38-0.76) were significantly more effective than warfarin in preventing post-thrombotic syndrome.
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