Safety and Effectiveness of Direct Oral Anticoagulants Versus Warfarin in Patients with Venous Thromboembolism using Real-World Data: A Systematic Review and Meta-Analysis.

Autor: Alshahrani WA; Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Alshahrani RS; Department of Clinical Pharmacy, King Saud Medical City, Riyadh, Saudi Arabia., Alkathiri MA; Department of Clinical Pharmacy, King Saud Medical City, Riyadh, Saudi Arabia., Alay SM; Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Alabkka AM; Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia., Alaraj SA; Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia., Al Yami MS; Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.; Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia., Altayyar WA; Drug Sector, Saudi Food and Drug Authority, Riyadh, Saudi Arabia., Alfayez OM; Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia. oalfayez@qu.edu.sa., Basoodan MS; Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia., Almutairi AR; Drug Sector, Saudi Food and Drug Authority, Riyadh, Saudi Arabia., Almohammed OA; Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.; Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
Jazyk: angličtina
Zdroj: American journal of cardiovascular drugs : drugs, devices, and other interventions [Am J Cardiovasc Drugs] 2024 Nov; Vol. 24 (6), pp. 823-839. Date of Electronic Publication: 2024 Sep 10.
DOI: 10.1007/s40256-024-00677-x
Abstrakt: Background: Direct oral anticoagulants (DOACs) have shown comparable efficacy and a superior safety profile in clinical trials for patients with venous thromboembolism (VTE). However, further study is needed to assess DOACs' effectiveness and safety compared to warfarin in a real-world context. Thus, this meta-analysis compares the effectiveness and safety of warfarin and DOACs in patients with VTE.
Method: A systematic review of the literature using PubMed and EMBASE was conducted from inception until June 2024. We examined observational studies that compared safety and effectiveness between DOACs and warfarin when used in treating VTE and reported adjusted hazard ratios (HRs) and/or odds ratios (ORs) for recurrent VTE, major bleeding, clinically relevant non-major bleeding, gastrointestinal bleeding, intracranial hemorrhage, and death from any cause. We then estimated the pooled effect using the random-effects model for meta-analysis.
Results: A total of 25 studies were included in the current meta-analysis. DOAC therapy was associated with significantly lower risks of recurrent VTE (HR 0.76, 95% confidence interval [CI] 0.69-0.85), major bleeding (HR 0.77, 95% CI 0.72-0.83), clinically relevant non-major bleeding (HR 0.82, 95% CI 0.77-0.88), and gastrointestinal bleeding (HR 0.75, 95% CI 0.68-0.83) compared to warfarin. However, no statistically significant difference was observed in all-cause mortality between the two groups (HR 0.96, 95% CI 0.83-1.10).
Conclusion: This meta-analysis found that DOACs are associated with a significant reduction in VTE recurrence in addition to the known favorable safety profile when compared to warfarin.
(© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
Databáze: MEDLINE
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