Key result
Rivaroxaban reduces recurrent VTE risk ~32% compared to standard of care.
Why the study?
Rivaroxaban and apixaban are the most widely used NOACs in VTE, but a meta-analysis was needed to evaluate their real-world effectiveness and safety versus standard of care.
Does rivaroxaban or apixaban reduce recurrent venous thromboembolism and major bleeding compared to standard of care in adult patients with venous thromboembolism in real-world settings?
Meta-Analysis
Does rivaroxaban or apixaban reduce recurrent venous thromboembolism and major bleeding compared to standard of care in adult patients with venous thromboembolism in real-world settings?
Hazard Ratio: 0.68 (95% CI 0.6–0.76)
Real-world evidence confirms that both rivaroxaban and apixaban are effective and safe alternatives to conventional standard of care for treating venous thromboembolism.
May support rivaroxaban or apixaban over standard care to reduce recurrent VTE; extends RCT data in real-world settings but requires prospective confirmation.
Background: Rivaroxaban and apixaban are the most widely used nonvitamin K oral anticoagulants (NOACs) in patients with venous thromboembolism (VTE). This meta-analysis evaluates the effectiveness and safety of both NOACs versus standard of care (SoC) in real-world practice. Methods: Real-world evidence (RWE) studies were identified through a systematic literature review conducted between January 2012 and July 2020, using Embase, MEDLINE, and the websites of cardiological, hematological, and oncological associations. Eligible RWE studies recruited adult patients with deep vein thrombosis and/or pulmonary embolism and presented a comparison between rivaroxaban and apixaban versus SoC, consisting either of vitamin K antagonists, heparins, or combinations thereof. Hazard ratios (HRs) for the comparison between NOACs and SoC were extracted from the relevant studies or estimated based on the reported binary data. The between-treatment contrasts were reported as HRs with associated 95% confidence intervals. Results: A total of 65 RWE studies were identified and considered relevant for the meta-analysis. Compared with SoC, both rivaroxaban and apixaban were associated with reduced risks of recurrent VTE and a lower rate of major bleeding events. Patients treated with rivaroxaban were at a lower risk of all-cause death compared with those receiving SoC (HR = 0.56 [0.39-0.80]), while evidence for apixaban from the identified studies was insufficient to demonstrate a statistically significant change in mortality (HR = 0.66 [0.30-1.47]). Conclusion: This analysis indicates that in real-world practice, rivaroxaban and apixaban are associated with a lower risk of recurrent VTE and major bleeding events compared with SoC. Survival benefit in patients treated with rivaroxaban was also observed.
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Wu et al. (2022) conducted a meta-analysis in Venous thromboembolism (VTE). Rivaroxaban and Apixaban vs. Standard of care (vitamin K antagonists, heparins, or combinations thereof) was evaluated on Recurrent venous thromboembolism (Rivaroxaban vs Standard of care) (HR 0.68, 95% CI 0.60-0.76). Rivaroxaban significantly reduced the risk of recurrent VTE by 32% (HR 0.68, 95% CI 0.60-0.76) and apixaban by 17% (HR 0.83, 95% CI 0.73-0.93) compared to standard of care.
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