Why the study?
To evaluate anticoagulant therapy with the use of NOACs, which have emerged as alternatives to traditional heparin and vitamin K antagonists.
Do NOACs improve efficacy and reduce bleeding compared to conventional anticoagulants in adults requiring anticoagulant therapy?
Do NOACs improve efficacy and reduce bleeding compared to conventional anticoagulants in adults requiring anticoagulant therapy?
NOACs are a reasonable and safe alternative to conventional anticoagulants, offering similar efficacy for thromboembolism prevention with reduced bleeding risk, though many underlying trials have high risk of bias.
NOACs match conventional anticoagulants on thromboembolic efficacy while reducing bleeding; supports reasonable alternative use but leaves open need for stronger trials.
Introduction: Anticoagulant therapy is defined as the standard prevention and treatment method for systemic thromboembolism. Thus, despite heparin and vitamin K antagonists being used as traditional methods, the new oral anticoagulants (NOACs), such as activated factor X inhibitors and direct thrombin inhibitors have been emerged, based on their safety and efficacy analyses appropriate to clinical practice, in addition to its convenience in clinical management. Objectives: To evaluate anticoagulant therapy with the use of NOACs. Methods: This is a systematic review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes criteria. Studies from the National Library of Medicine (PubMed.gov) and Embase databases were included, through randomized clinical trials (RCTs), published from 2011 until June 2021, which comprised the investigation question. Data were extracted about the NOACs, the conventional anticoagulant, use in renal patients, clinical outcomes and side effects. Results: 384 results were identified through the search strategy, proceeding to the analysis of 315 after exclusion of duplicates. Then, after the application of the eligibility criteria, 33 studies progressed to full reading and 18 were included in the qualitative analysis of the review. The included studies demonstrated the analysis of specific comorbidities, and most comprised the adult population and warfarin as a conventional anticoagulant used. Edoxaban was the most evaluated NOAC, being included in 7 studies. Bias analysis found 3 “low risk” studies and 7 overall “high risk” studies. Conclusion: The comparison of conventional therapy and NOACs demonstrates similarity in the efficacy clinical outcomes analyzed by the studies, with similar reductions of the risk of thromboembolic events. From the analysis of the occurrence of bleeding, NOACs represent reduced rates of such outcomes. Regarding the analysis of the risk of bias of the studies, 15 of the 18 studies analyzed were classified as “high risk of bias” or as “some concerns”, especially in the criteria of “missing outcome data. In general, although no methodologically strong evidence has been identified about NOACs, their use is a reasonable alternative to conventional therapy in clinical management.
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Santos et al. (2023) studied this question.
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