November 1, 2014Vascular Health and Risk ManagementOpen Access

Direct oral anticoagulants in the treatment of venous thromboembolism, with a focus on patients with pulmonary embolism: an evidence-based review

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Venous thromboembolism (VTE) and Pulmonary embolism (PE) (n=35019). Intervention: Direct oral anticoagulants (DOAC; dabigatran, rivaroxaban, apixaban, edoxaban) vs. Standard treatment, warfarin, or placebo. Primary outcome: Recurrent VTE in patients with index PE (acute/long-term treatment) (RR 0.88, 95% CI 0.70-1.11).

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Key result

DOACs showed comparable efficacy to standard treatment in preventing recurrent VTE in patients with index PE (RR 0.88; 95% CI 0.70-1.11) and were more effective than placebo for extended therapy.

Why the study?

Do direct oral anticoagulants prevent recurrent VTE compared to standard treatment or placebo in patients with venous thromboembolism?

Population

35,019 randomized patients with venous thromboembolism from 10 studies, including 14,364 with index…

Comparison

Direct oral anticoagulants for acute/long-term… vs Standard treatment or placebo.

Design

Meta-analysis

Authors

AGAntonio Gómez‐OutesEuropean Medicines Agency MSMa Luisa Suárez‐GeaAgencia Española de Medicamentos y Productos Sanitarios RLRamón LecumberriClinica Universidad de Navarra

Discussion

Member takes

Overview

Supports DOAC use for acute PE and extended VTE therapy; reinforces Level 1 evidence for guideline-directed anticoagulation.

Study Design

Type

Meta-Analysis (n=35,019)

Structured PICO

Do direct oral anticoagulants prevent recurrent VTE compared to standard treatment or placebo in patients with venous thromboembolism?

Population

35,019 randomized patients from ten studies evaluating DOACs for acute/long-term and extended therapy of VTE, including 14,364 with index PE.

Intervention

Direct oral anticoagulants (DOAC; dabigatran, rivaroxaban, apixaban, edoxaban) for acute/long-term and extended therapy of VTE.

Comparator

Standard treatment (including warfarin) or placebo (for extended therapy).

Outcome

Recurrent VTEhard clinical

Main Result

Relative Risk: 0.88 (95% CI 0.7–1.11)

DOACs are as effective and safer than standard treatment for acute VTE, including hemodynamically stable PE, and more effective than placebo for extended therapy despite an increased bleeding risk.

Limitations

Data on VTE recurrence depending on PE anatomical extension and presence/absence of right ventricular dysfunction are limited.
Limited data on VTE recurrence depending on PE anatomical extension and presence/absence of right ventricular dysfunction (only reported in two trials)

Cite This Study

Gómez‐Outes et al. (2014) conducted a meta-analysis in Venous thromboembolism (VTE) and Pulmonary embolism (PE) (n=35,019). Direct oral anticoagulants (DOAC; dabigatran, rivaroxaban, apixaban, edoxaban) vs. Standard treatment, warfarin, or placebo was evaluated on Recurrent VTE in patients with index PE (acute/long-term treatment) (RR 0.88, 95% CI 0.70-1.11). DOACs showed comparable efficacy to standard treatment in preventing recurrent VTE in patients with index PE (RR 0.88; 95% CI 0.70-1.11) and were more effective than placebo for extended therapy.

synapsesocial.com/papers/6a870011a810ea404bcf9cf3 https://doi.org/10.2147/vhrm.s50543

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November 1, 2014Vascular Health and Risk ManagementOpen Access

Direct oral anticoagulants in the treatment of venous thromboembolism, with a focus on patients with pulmonary embolism: an evidence-based review

View Full Paper

Ask AI

Bookmark

Key result

DOACs showed comparable efficacy to standard treatment in preventing recurrent VTE in patients with index PE (RR 0.88; 95% CI 0.70-1.11) and were more effective than placebo for extended therapy.

Why the study?

Do direct oral anticoagulants prevent recurrent VTE compared to standard treatment or placebo in patients with venous thromboembolism?

Population

35,019 randomized patients with venous thromboembolism from 10 studies, including 14,364 with index…

Comparison

Direct oral anticoagulants for acute/long-term… vs Standard treatment or placebo.

Design

Meta-analysis

Authors

AGAntonio Gómez‐OutesEuropean Medicines Agency MSMa Luisa Suárez‐GeaAgencia Española de Medicamentos y Productos Sanitarios RLRamón LecumberriClinica Universidad de Navarra

Discussion

Member takes

Overview

Supports DOAC use for acute PE and extended VTE therapy; reinforces Level 1 evidence for guideline-directed anticoagulation.

Study Design

Type

Meta-Analysis (n=35,019)

Structured PICO

Do direct oral anticoagulants prevent recurrent VTE compared to standard treatment or placebo in patients with venous thromboembolism?

Population

35,019 randomized patients from ten studies evaluating DOACs for acute/long-term and extended therapy of VTE, including 14,364 with index PE.

Intervention

Direct oral anticoagulants (DOAC; dabigatran, rivaroxaban, apixaban, edoxaban) for acute/long-term and extended therapy of VTE.

Comparator

Standard treatment (including warfarin) or placebo (for extended therapy).

Outcome

Recurrent VTEhard clinical

Main Result

Relative Risk: 0.88 (95% CI 0.7–1.11)

DOACs are as effective and safer than standard treatment for acute VTE, including hemodynamically stable PE, and more effective than placebo for extended therapy despite an increased bleeding risk.

Limitations

Data on VTE recurrence depending on PE anatomical extension and presence/absence of right ventricular dysfunction are limited.
Limited data on VTE recurrence depending on PE anatomical extension and presence/absence of right ventricular dysfunction (only reported in two trials)

Cite This Study

synapsesocial.com/papers/6a870011a810ea404bcf9cf3 https://doi.org/10.2147/vhrm.s50543

Also Consider

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

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