What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Venous thromboembolism with renal insufficiency (n=9680). Intervention: Novel oral anticoagulants (NOACs) vs. Low molecular weight heparin (LMWH). Primary outcome: Bleeding in the acute phase (RR 1.29, 95% CI 1.04-1.60).

February 5, 2024Thrombosis JournalOpen Access

Efficacy and safety of anticoagulant for treatment and prophylaxis of VTE patients with renal insufficiency: a systemic review and meta-analysis

Q: What are the key findings of this study?

In patients with venous thromboembolism and renal insufficiency, novel oral anticoagulants increased the risk of bleeding compared to low molecular weight heparin during the acute phase (RR 1.29).

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Key result

NOACs increase acute bleeding risk ~29% vs LMWH in VTE patients with renal insufficiency.

RR 1.29
95% CI 1.04-1.60
n=9,680

Why the study?

Patients with VTE comorbid renal insufficiency face higher risks of bleeding and thrombosis, but guideline recommendations on anticoagulation therapy remain ambiguous.

Do different anticoagulant regimens alter the risk of recurrent VTE, death, and bleeding in VTE patients with comorbid renal insufficiency?

Comparison

Different anticoagulant regimens for VTE treatment and prophylaxis

Design

Systematic review and meta-analysis of RCTs

Authors

SMShuangshuang Ma GFGuohui Fan FXFeiya Xu

Discussion

Member takes

Overview

LMWH may be favored over NOACs for acute VTE in renal insufficiency to limit bleeding; challenges NOAC preference in this population.

Study Design

Type

Meta-Analysis (n=9,680)

Structured PICO

Do different anticoagulant regimens alter the risk of recurrent VTE, death, and bleeding in VTE patients with comorbid renal insufficiency?

Population

9,680 adult patients with venous thromboembolism and comorbid renal insufficiency across 25 randomized controlled trials evaluating anticoagulants for treatment and prophylaxis.

Intervention

Anticoagulant regimens including novel oral anticoagulants (NOACs), low molecular weight heparin (LMWH), vitamin K antagonists (VKA), unfractionated heparin (UFH), desirudin, or aspirin.

Comparator

Active comparators (other anticoagulants) or placebo.

Outcome

Efficacy (recurrent VTE or VTE-related death for treatment; asymptomatic or symptomatic VTE or VTE-related death for prophylaxis) and Safety (major bleeding and/or clinically relevant non-major bleeding).composite

Main Result

Relative Risk: 1.29 (95% CI 1.04–1.6)

In patients with renal insufficiency, LMWH appears to be the most effective and safe option for VTE treatment and prophylaxis, as NOACs and VKAs are associated with significantly higher bleeding risks.

Limitations

Most clinical trials excluded patients with CrCl < 30 mL/min
CrCl was estimated before enrollment and dynamic changes were not monitored during treatment
Different compounds of LMWH and NOACs and comorbidities across studies may impact prognoses
Different compounds of LMWH and NOACs and comorbidities in different studies may impact prognoses

Cite This Study

Ma et al. (2024) conducted a meta-analysis in Venous thromboembolism with renal insufficiency (n=9,680). Novel oral anticoagulants (NOACs) vs. Low molecular weight heparin (LMWH) was evaluated on Bleeding in the acute phase (RR 1.29, 95% CI 1.04-1.60). In patients with venous thromboembolism and renal insufficiency, novel oral anticoagulants increased the risk of bleeding compared to low molecular weight heparin during the acute phase (RR 1.29).

synapsesocial.com/papers/6a1f153adc19c09dd39143c5 https://doi.org/10.1186/s12959-023-00576-2

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February 5, 2024Thrombosis JournalOpen Access

Efficacy and safety of anticoagulant for treatment and prophylaxis of VTE patients with renal insufficiency: a systemic review and meta-analysis

View Full Paper

Ask AI

Bookmark

Key result

NOACs increase acute bleeding risk ~29% vs LMWH in VTE patients with renal insufficiency.

RR 1.29
95% CI 1.04-1.60
n=9,680

Why the study?

Patients with VTE comorbid renal insufficiency face higher risks of bleeding and thrombosis, but guideline recommendations on anticoagulation therapy remain ambiguous.

Do different anticoagulant regimens alter the risk of recurrent VTE, death, and bleeding in VTE patients with comorbid renal insufficiency?

Comparison

Different anticoagulant regimens for VTE treatment and prophylaxis

Design

Systematic review and meta-analysis of RCTs

Authors

SMShuangshuang Ma GFGuohui Fan FXFeiya Xu

Discussion

Member takes

Overview

LMWH may be favored over NOACs for acute VTE in renal insufficiency to limit bleeding; challenges NOAC preference in this population.

Study Design

Type

Meta-Analysis (n=9,680)

Structured PICO

Do different anticoagulant regimens alter the risk of recurrent VTE, death, and bleeding in VTE patients with comorbid renal insufficiency?

Population

9,680 adult patients with venous thromboembolism and comorbid renal insufficiency across 25 randomized controlled trials evaluating anticoagulants for treatment and prophylaxis.

Intervention

Anticoagulant regimens including novel oral anticoagulants (NOACs), low molecular weight heparin (LMWH), vitamin K antagonists (VKA), unfractionated heparin (UFH), desirudin, or aspirin.

Comparator

Active comparators (other anticoagulants) or placebo.

Outcome

Main Result

Relative Risk: 1.29 (95% CI 1.04–1.6)

Limitations

Most clinical trials excluded patients with CrCl < 30 mL/min
CrCl was estimated before enrollment and dynamic changes were not monitored during treatment
Different compounds of LMWH and NOACs and comorbidities across studies may impact prognoses
Different compounds of LMWH and NOACs and comorbidities in different studies may impact prognoses

Cite This Study

synapsesocial.com/papers/6a1f153adc19c09dd39143c5 https://doi.org/10.1186/s12959-023-00576-2

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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