Causes of Death in Patients with Venous Thromboembolism Anticoagulated with Direct Oral Anticoagulants: A Systematic Review and Meta-Analysis.

Autor:	Gómez-Outes A; Division of Pharmacology and Clinical Drug Evaluation, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain., Terleira-Fernández AI; Department of Clinical Pharmacology, Hospital Clínico San Carlos, Madrid, Spain.; Department of Pharmacology, Universidad Complutense, Madrid, Spain., Lecumberri R; Hematology Service, University Clinic of Navarra, Pamplona, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain., Suárez-Gea ML; Division of Pharmacology and Clinical Drug Evaluation, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain., Calvo-Rojas G; Department of Clinical Pharmacology, Hospital Clinic, Barcelona, Spain., Vargas-Castrillón E; Department of Clinical Pharmacology, Hospital Clínico San Carlos, Madrid, Spain.; Department of Pharmacology, Universidad Complutense, Madrid, Spain.
Jazyk:	angličtina
Zdroj:	Seminars in thrombosis and hemostasis [Semin Thromb Hemost] 2018 Jun; Vol. 44 (4), pp. 377-387. Date of Electronic Publication: 2018 May 03.
DOI:	10.1055/s-0038-1642644
Abstrakt:	Death is more frequent than nonfatal recurrent venous thromboembolism (VTE) and major bleeding after acute VTE. The analysis of the causes of death is fundamental to explore new strategies to reduce mortality rates in these patients. The authors performed a meta-analysis to analyze mortality and independently adjudicated causes of death in anticoagulated patients due to VTE, and to evaluate potential differences between different anticoagulant schemes. They searched MEDLINE and CENTRAL, from January 1, 2000, to January 31, 2017, and performed additional searches in Web sites of regulatory agencies, clinical trial registers, and conference proceedings. Two investigators independently selected studies and extracted the data. Study quality was assessed with the Cochrane Collaboration's tool for assessing the risk of bias in randomized studies. Seven prospective randomized trials in 29,844 patients (22,025 patient-year follow-up) were included, comparing dabigatran, rivaroxaban, apixaban, and edoxaban with the standard anticoagulant treatment of VTE. A total of 718 patients died during the follow-up (3.4% per year; 95% confidence interval [CI]: 2.3-4.8). The most frequent causes of death were cancer (42%), followed by VTE (20%), infections (13%), hemorrhage (6%), heart disease (4%), and stroke (2%). There were no differences in the overall survival and causes of death according to the anticoagulant type. Concomitant active cancer during the study was significantly associated with death (odds ratio: 15.2; 95% CI: 9.2-25.1). Cancer is the leading cause of death in contemporary VTE trials. Interventions beyond anticoagulation, particularly in patients with active cancer, are needed. Competing Interests: Dr. Lecumberri reports personal fees from Boehringer-Ingelheim and Bristol-Myers Squibb outside the submitted work. No other conflicts are reported. (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)
Databáze:	MEDLINE
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