Oral anticoagulant regimens and aspirin for extented venous thromboembolism treatment

  • Wang KL & al.
  • Heart
  • 16 Oct 2018

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Standard-intensity vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) were associated with lower risk for recurrent venous thromboembolism (VTE) vs placebo/observation and aspirin in patients receiving extended treatment for VTE.

Why this matters

  • Findings suggest aspirin should not be considered for extended VTE treatment and further justify extending anticoagulation treatment with standard-intensity VKAs or DOACs in patients for whom extended VTE treatment is considered.

Study design

  • Meta-analysis of 16 studies including 22,396 patients which compared extended treatments for secondary prevention of VTE.
  • Primary outcomes were recurrent VTE and major bleeding.
  • Funding: None disclosed.

Key results

  • Compared with placebo or observation, the risk for recurrent VTE was lower with:
    • standard-intensity VKAs (OR, 0.145; 95% credible interval [CrI], 0.075-0.242);
    • low-dose factor Xa inhibitors (OR, 0.156; 95% CrI, 0.060-0.381);
    • standard-dose factor Xa inhibitors (OR, 0.170; 95% CrI, 0.083-0.334);
    • direct thrombin inhibitor (OR, 0.146; 95% CrI, 0.043-0.366).
  • Compared with aspirin, the risk for recurrent VTE was lower with:
    • standard-intensity VKAs (OR, 0.234; 95% CrI, 0.088-0.542);
    • low-dose factor Xa inhibitors (OR, 0.250; 95% CrI, 0.092-0.665);
    • standard-dose factor Xa inhibitors (OR, 0.272; 95% CrI, 0.115-0.646);
    • direct thrombin inhibitor (OR, 0.235; 95% CrI, 0.057-0.741).
  • The risk for major bleeding was higher with standard-intensity VKAs vs placebo/observation (OR, 4.415; 95% CrI, 1.988-12.240) and aspirin (OR, 4.137; 95% CrI, 1.166-18.860).

Limitations

  • Findings may not be generalisable.

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