Direct oral anticoagulants compared with vitamin K antagonists for acute venous thromboembolism: evidence from phase 3 trials
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- 18 September 2014
- journal article
- research article
- Published by American Society of Hematology in Blood
- Vol. 124 (12), 1968-1975
- https://doi.org/10.1182/blood-2014-04-571232
Abstract
In the last 4 years, 6 phase 3 trials including a total of 27 023 patients with venous thromboembolism (VTE) compared a direct oral anticoagulant (DOAC) with vitamin K antagonists (VKAs). To aid the clinician in assessing the amount of information, we address frequently raised clinical questions in a review of combined trial results. We included the phase 3 trials that compared dabigatran etexilate, rivaroxaban, apixaban, or edoxaban with VKA therapy in patients with acute symptomatic VTE. Recurrent VTE occurred in 2.0% of DOAC recipients compared with 2.2% in VKA recipients (relative risk [RR] 0.90, 95% confidence interval [CI] 0.77-1.06). Treatment with a DOAC significantly reduced the risk of major bleeding (RR 0.61, 95% CI 0.45-0.83). In parallel, intracranial bleeding, fatal bleeding, and clinically relevant nonmajor bleeding occurred significantly less in DOAC recipients. The efficacy and safety of DOACs were consistent in patients with pulmonary embolism, deep venous thrombosis, a body weight ≥100 kg, moderate renal insufficiency, an age ≥75 years, and cancer. In conclusion, DOACs and VKAs have similar efficacy in the treatment of acute symptomatic VTE, a finding that is consistent in key clinical subgroups. Treatment with a DOAC significantly reduces the risks of major bleeding.Keywords
This publication has 14 references indexed in Scilit:
- Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trialsThe Lancet, 2014
- Treatment of Acute Venous Thromboembolism With Dabigatran or Warfarin and Pooled AnalysisCirculation, 2014
- Edoxaban versus Warfarin for the Treatment of Symptomatic Venous ThromboembolismThe New England Journal of Medicine, 2013
- Oral Apixaban for the Treatment of Acute Venous ThromboembolismThe New England Journal of Medicine, 2013
- Oral Rivaroxaban for the Treatment of Symptomatic Pulmonary EmbolismThe New England Journal of Medicine, 2012
- Antithrombotic Therapy for VTE Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice GuidelinesSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2012
- Oral Rivaroxaban for Symptomatic Venous ThromboembolismThe New England Journal of Medicine, 2010
- Dabigatran versus Warfarin in the Treatment of Acute Venous ThromboembolismThe New England Journal of Medicine, 2009
- Duration of treatment with vitamin K antagonists in symptomatic venous thromboembolismPublished by Wiley ,2006
- Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non‐surgical patientsJournal of Thrombosis and Haemostasis, 2005