Anticoagulant selection for patients with VTE—Evidence from a systematic literature review of network meta-analyses
Key result
Apixaban significantly reduced major bleeding (effect estimates 0.30-0.43) and clinically relevant bleeding (0.23-0.72) compared to other anticoagulants in VTE, with similar efficacy.
Why the study?
In the absence of head-to-head trials, the study aimed to systematically review published network meta-analyses comparing direct oral anticoagulants and other treatments for VTE.
Does apixaban reduce bleeding compared to other anticoagulants in patients with VTE?
Population
Nine network meta-analyses comprising 68 randomized controlled trials of VTE patients
Comparison
DOACs vs each other, low-molecular weight heparin, unfractionated heparin, and VKAs
Design
Systematic literature review of network meta-analyses
Authors
Discussion
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Member takes
Implication
Reinforces DOAC preference for VTE; confirms consistency of efficacy-safety findings across published NMAs.
Study Design
Type
Systematic Review
Structured PICO
Does apixaban reduce bleeding compared to other anticoagulants in patients with VTE?
P
Population
Systematic literature review of 9 network meta-analyses (comprising 68 trials) evaluating DOACs for acute and extended treatment of VTE.
I
Intervention
Apixaban
C
Comparator
Other DOACs (dabigatran, edoxaban, rivaroxaban), low-molecular weight heparin, unfractionated heparin, and vitamin K antagonists (VKAs)
O
Outcome
Major bleeding and clinically relevant bleeding (CRB)safety
Main Result
Effect estimate: effect estimates 0.30-0.43 (major bleeding)
In a systematic review of network meta-analyses, apixaban was associated with significantly lower rates of major and clinically relevant bleeding compared to other DOACs and VKAs for VTE treatment, with comparable efficacy.
Limitations
- Absence of head-to-head trials (relies on indirect evidence)
Cite This Study
Cohen et al. (2019) conducted a systematic review in Venous thromboembolism (VTE). Apixaban vs. Other DOACs, LMWH, UFH, and VKAs was evaluated on Major bleeding and clinically relevant bleeding (CRB) (effect estimates 0.30-0.43 (major bleeding)). Apixaban significantly reduced major bleeding (effect estimates 0.30-0.43) and clinically relevant bleeding (0.23-0.72) compared to other anticoagulants in VTE, with similar efficacy.