Efficacy and safety outcomes of oral anticoagulants and antiplatelet drugs in the secondary prevention of venous thromboembolism: systematic review and network meta-analysis
| Autor: | Marc A. Rodger, George A. Wells, Doug Coyle, Esteban Gandara, Chris Cameron, Marc Carrier, Philip S. Wells, Tammy Clifford, Grégoire Le Gal, Lana A Castellucci |
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| Přispěvatelé: | Thrombosis Program, University of Ottawa [Ottawa], Epidemiology and Community Medicine (OTTAWA - ECM), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Clinical Epidemiology Unit, Ottawa-The Ottawa Hospital, Canadian Agency for Drugs and Technologies in Health (OTTAWA - CADTH), Ottawa, Department of Medicine, Ottawa Hospital, Calvez, Ghislaine |
| Jazyk: | angličtina |
| Rok vydání: | 2013 |
| Předmět: |
Vitamin K
[SDV]Life Sciences [q-bio] MESH: Calcium Channel Blockers 030204 cardiovascular system & hematology MESH: Venous Thromboembolism 0302 clinical medicine Rivaroxaban Recurrence Medicine MESH: Animals 030212 general & internal medicine MESH: Organ Specificity Absolute risk reduction Venous Thromboembolism General Medicine MESH: Muscle Smooth Vascular MESH: Thiophenes Dabigatran 3. Good health [SDV] Life Sciences [q-bio] MESH: beta-Alanine MESH: Platelet Aggregation Inhibitors Meta-analysis Anesthesia MESH: Chemistry Apixaban MESH: Cats MESH: Hemorrhage medicine.drug medicine.medical_specialty MESH: Terminology as Topic MESH: Rats Pyridones Morpholines MEDLINE MESH: Morpholines Hemorrhage Thiophenes MESH: Anticoagulants Placebo MESH: Nervous System Diseases 03 medical and health sciences Internal medicine MESH: Pyridones Humans MESH: Aspirin MESH: Humans Aspirin business.industry Anticoagulants MESH: Cardiovascular Diseases MESH: Vitamin K MESH: Chemical Phenomena Odds ratio MESH: Recurrence MESH: Heart beta-Alanine Pyrazoles Benzimidazoles business MESH: Benzimidazoles Platelet Aggregation Inhibitors MESH: Pyrazoles |
| Zdroj: | European Neurology European Neurology, Karger, 2013, 347, pp.f5133 |
| ISSN: | 0014-3022 1421-9913 |
| Popis: | International audience; OBJECTIVE: To summarise and compare the efficacy and safety of various oral anticoagulants (dabigatran, rivaroxaban, apixaban, and vitamin K antagonists) and antiplatelet agents (acetylsalicylic acid) for the secondary prevention of venous thromboembolism. DESIGN: Systematic review and network meta-analysis. DATA SOURCES: Literature search using Medline (1950 to present), Embase (1980 to present), and the Cochrane Register of Controlled Trials using the OVID interface. Publications from potentially relevant journals were also searched by hand. REVIEW METHODS: Randomised controlled trials of patients receiving anticoagulants, antiplatelet drugs, or placebo or observation for secondary prevention of venous thromboembolism. Selected outcomes were rates of recurrent venous thromboembolism and major bleeding. Two reviewers independently extracted data onto standardised forms. RESULTS: 12 articles met our inclusion criteria, with 11,999 patients evaluated for efficacy and 12,167 for safety. All treatments reduced the risk of recurrent venous thromboembolism. Compared with placebo or observation, vitamin K antagonists at a standard adjusted dose (target international normalised ratio 2.0-3.0) showed the highest risk difference (odds ratio 0.07; 95% credible interval 0.03 to 0.15) and acetylsalicylic acid showed the lowest risk difference (0.65; 0.39 to 1.03). Risk of major bleeding was higher with a standard adjusted dose of vitamin K antagonists (5.24; 1.78 to 18.25) than with placebo or observation. Fatal recurrent venous thromboembolism and fatal bleeding were rare. Detailed subgroup and individual patient level data were not available. CONCLUSIONS: All oral anticoagulants and antiplatelet agents investigated in this analysis were associated with a reduced recurrence of venous thromboembolism compared with placebo or observation, although acetylsalicylic acid was associated with the lowest risk reduction. Vitamin K antagonists given at a standard adjusted dose was associated with the greatest risk reduction in recurrent venous thromboembolism, but also the greatest risk of major bleeding. |
| Databáze: | OpenAIRE |
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