Comparative efficacy and safety of anticoagulants and aspirin for extended treatment of venous thromboembolism: A network meta-analysis

Main Author: Sobieraj, Diana M.
Other Authors: Coleman, Craig I., Pasupuleti, Vinay, Deshpande, Abhishek, Kaw, Roop, Hernández, Adrian V.
Format: Artículo
Language: eng
Published: 2015
Subjects:
Online Access: http://hdl.handle.net/10757/346496
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spelling Sobieraj, Diana M.Coleman, Craig I.Pasupuleti, VinayDeshpande, AbhishekKaw, RoopHernández, Adrian V.2015-03-10T20:19:07Z2015-03-10T20:19:07Z2015-03-091. Sobieraj DM, Coleman CI, Pasupuleti V, Deshpande A, Kaw R, Hernandez A V. Comparative efficacy and safety of anticoagulants and aspirin for extended treatment of venous thromboembolism: A network meta-analysis. Thromb Res [Internet]. Elsevier B.V.; 2015; Available from: http://linkinghub.elsevier.com/retrieve/pii/S00493848150010480049-384810.1016/j.thromres.2015.02.032http://hdl.handle.net/10757/346496Thrombosis ResearchDiana.sobieraj@hhchealth.orgObjective To systematically review the literature and to quantitatively evaluate the efficacy and safety of extended pharmacologic treatment of venous thromboembolism (VTE) through network meta-analysis (NMA). Methods A systematic literature search (MEDLINE, Embase, Cochrane CENTRAL, through September 2014) and searching of reference lists of included studies and relevant reviews was conducted to identify randomized controlled trials of patients who completed initial anticoagulant treatment for VTE and then randomized for the extension study; compared extension of anticoagulant treatment to placebo or active control; and reported at least one outcome of interest (VTE or a composite of major bleeding or clinically relevant non-major bleeding). A random-effects Frequentist approach to NMA was used to calculate relative risks with 95% confidence intervals. Results Ten trials (n=11,079) were included. Risk of bias (assessed with the Cochrane tool) was low in most domains assessed across the included trials. Apixaban (2.5mg and 5mg), dabigatran, rivaroxaban, idraparinux and vitamin K antagonists (VKA) each significantly reduced the risk of VTE recurrence compared to placebo, ranging from a 73% reduction with idraparinux to 86% with VKAs. With exception of idraparinux, all active therapies significantly reduced VTE recurrence risk versus aspirin, ranging from a 73% reduction with either apixaban 2.5mg or rivaroxaban to 80% with VKAs. Apixaban and aspirin were the only therapies that did not increase composite bleeding risk significantly compared to placebo. All active therapies except aspirin increased risk of composite bleeding by 2 to 4-fold compared to apixaban 2.5mg, with no difference found between the two apixaban doses. Conclusion Extended treatment of VTE is a reasonable approach to provide continued protection from VTE recurrence although bleeding risk is variable across therapeutic options. Our results indicate that apixaban, dabigatran, rivaroxaban, idraparinux and VKAs all reduced VTE recurrence when compared to placebo. Apixaban appears to have a more favorable safety profile compared to other therapies.Revisión por paresapplication/pdfengElsevier B.V.http://www.thrombosisresearch.com/article/S0049-3848%2815%2900104-8/abstractinfo:eu-repo/semantics/openAccessUniversidad Peruana de Ciencias Aplicadas (UPC)Repositorio Académico - UPCreponame:UPC-Institucionalinstname:Universidad Peruana de Ciencias Aplicadasinstacron:UPCVenous thromboembolismbb21d7d1-7b04-4969-9890-88fcfcc22b36600Anticoagulant02a13e91-e74e-4ce0-b515-ed0910a2f63e600Antiplateletb4f5cd80-4ce8-406a-be5c-12f405557249600Deep vein thrombosisfd0640e6-d653-4594-91ef-8dee52f33802600Pulmonary embolism755a612b-981d-4a04-8882-f2e16c5ac0eb600Comparative efficacy and safety of anticoagulants and aspirin for extended treatment of venous thromboembolism: A network meta-analysisinfo:eu-repo/semantics/article2018-06-15T22:06:20ZObjective To systematically review the literature and to quantitatively evaluate the efficacy and safety of extended pharmacologic treatment of venous thromboembolism (VTE) through network meta-analysis (NMA). Methods A systematic literature search (MEDLINE, Embase, Cochrane CENTRAL, through September 2014) and searching of reference lists of included studies and relevant reviews was conducted to identify randomized controlled trials of patients who completed initial anticoagulant treatment for VTE and then randomized for the extension study; compared extension of anticoagulant treatment to placebo or active control; and reported at least one outcome of interest (VTE or a composite of major bleeding or clinically relevant non-major bleeding). A random-effects Frequentist approach to NMA was used to calculate relative risks with 95% confidence intervals. Results Ten trials (n=11,079) were included. Risk of bias (assessed with the Cochrane tool) was low in most domains assessed across the included trials. Apixaban (2.5mg and 5mg), dabigatran, rivaroxaban, idraparinux and vitamin K antagonists (VKA) each significantly reduced the risk of VTE recurrence compared to placebo, ranging from a 73% reduction with idraparinux to 86% with VKAs. With exception of idraparinux, all active therapies significantly reduced VTE recurrence risk versus aspirin, ranging from a 73% reduction with either apixaban 2.5mg or rivaroxaban to 80% with VKAs. Apixaban and aspirin were the only therapies that did not increase composite bleeding risk significantly compared to placebo. All active therapies except aspirin increased risk of composite bleeding by 2 to 4-fold compared to apixaban 2.5mg, with no difference found between the two apixaban doses. Conclusion Extended treatment of VTE is a reasonable approach to provide continued protection from VTE recurrence although bleeding risk is variable across therapeutic options. Our results indicate that apixaban, dabigatran, rivaroxaban, idraparinux and VKAs all reduced VTE recurrence when compared to placebo. Apixaban appears to have a more favorable safety profile compared to other therapies.ORIGINALComparative efficacy.pdfComparative efficacy.pdfapplication/pdf1464069https://repositorioacademico.upc.edu.pe/bitstream/10757/346496/1/Comparative%20efficacy.pdf7fa97415477b6797afb72bc6d71600a3MD51trueLICENSElicense.txtlicense.txttext/plain; charset=utf-81659https://repositorioacademico.upc.edu.pe/bitstream/10757/346496/2/license.txt1ed8f33c5404431ad7aabc05080746c5MD52falseTEXTComparative efficacy.pdf.txtComparative efficacy.pdf.txtExtracted Texttext/plain40063https://repositorioacademico.upc.edu.pe/bitstream/10757/346496/3/Comparative%20efficacy.pdf.txtc1d3dd1af3004dad01de04ebc86f3488MD53falseTHUMBNAILComparative efficacy.pdf.jpgComparative efficacy.pdf.jpgGenerated Thumbnailimage/jpeg47144https://repositorioacademico.upc.edu.pe/bitstream/10757/346496/4/Comparative%20efficacy.pdf.jpg308ef32df7eb3551eb3ecb493cea197eMD54falseelsevier-thumbnail.pngapplication/octet-stream55176https://repositorioacademico.upc.edu.pe/bitstream/10757/346496/5/elsevier-thumbnail.pngfd459a452bb0de4492b9b87e6ac7e962MD55false10757/346496oai:repositorioacademico.upc.edu.pe:10757/3464962019-08-30 07:41:25.982Repositorio académico upcupc@openrepository.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
dc.title.es_PE.fl_str_mv Comparative efficacy and safety of anticoagulants and aspirin for extended treatment of venous thromboembolism: A network meta-analysis
title Comparative efficacy and safety of anticoagulants and aspirin for extended treatment of venous thromboembolism: A network meta-analysis
spellingShingle Comparative efficacy and safety of anticoagulants and aspirin for extended treatment of venous thromboembolism: A network meta-analysis
Sobieraj, Diana M.
Venous thromboembolism
Anticoagulant
Antiplatelet
Deep vein thrombosis
Pulmonary embolism
title_short Comparative efficacy and safety of anticoagulants and aspirin for extended treatment of venous thromboembolism: A network meta-analysis
title_full Comparative efficacy and safety of anticoagulants and aspirin for extended treatment of venous thromboembolism: A network meta-analysis
title_fullStr Comparative efficacy and safety of anticoagulants and aspirin for extended treatment of venous thromboembolism: A network meta-analysis
title_full_unstemmed Comparative efficacy and safety of anticoagulants and aspirin for extended treatment of venous thromboembolism: A network meta-analysis
title_sort Comparative efficacy and safety of anticoagulants and aspirin for extended treatment of venous thromboembolism: A network meta-analysis
author Sobieraj, Diana M.
author_facet Sobieraj, Diana M.
Coleman, Craig I.
Pasupuleti, Vinay
Deshpande, Abhishek
Kaw, Roop
Hernández, Adrian V.
author_role author
author2 Coleman, Craig I.
Pasupuleti, Vinay
Deshpande, Abhishek
Kaw, Roop
Hernández, Adrian V.
author2_role author
author
author
author
author
dc.contributor.author.fl_str_mv Sobieraj, Diana M.
Coleman, Craig I.
Pasupuleti, Vinay
Deshpande, Abhishek
Kaw, Roop
Hernández, Adrian V.
dc.subject.es_PE.fl_str_mv Venous thromboembolism
Anticoagulant
Antiplatelet
Deep vein thrombosis
Pulmonary embolism
topic Venous thromboembolism
Anticoagulant
Antiplatelet
Deep vein thrombosis
Pulmonary embolism
dc.description.es_PE.fl_txt_mv Diana.sobieraj@hhchealth.org
dc.description.abstract.none.fl_txt_mv Objective To systematically review the literature and to quantitatively evaluate the efficacy and safety of extended pharmacologic treatment of venous thromboembolism (VTE) through network meta-analysis (NMA). Methods A systematic literature search (MEDLINE, Embase, Cochrane CENTRAL, through September 2014) and searching of reference lists of included studies and relevant reviews was conducted to identify randomized controlled trials of patients who completed initial anticoagulant treatment for VTE and then randomized for the extension study; compared extension of anticoagulant treatment to placebo or active control; and reported at least one outcome of interest (VTE or a composite of major bleeding or clinically relevant non-major bleeding). A random-effects Frequentist approach to NMA was used to calculate relative risks with 95% confidence intervals. Results Ten trials (n=11,079) were included. Risk of bias (assessed with the Cochrane tool) was low in most domains assessed across the included trials. Apixaban (2.5mg and 5mg), dabigatran, rivaroxaban, idraparinux and vitamin K antagonists (VKA) each significantly reduced the risk of VTE recurrence compared to placebo, ranging from a 73% reduction with idraparinux to 86% with VKAs. With exception of idraparinux, all active therapies significantly reduced VTE recurrence risk versus aspirin, ranging from a 73% reduction with either apixaban 2.5mg or rivaroxaban to 80% with VKAs. Apixaban and aspirin were the only therapies that did not increase composite bleeding risk significantly compared to placebo. All active therapies except aspirin increased risk of composite bleeding by 2 to 4-fold compared to apixaban 2.5mg, with no difference found between the two apixaban doses. Conclusion Extended treatment of VTE is a reasonable approach to provide continued protection from VTE recurrence although bleeding risk is variable across therapeutic options. Our results indicate that apixaban, dabigatran, rivaroxaban, idraparinux and VKAs all reduced VTE recurrence when compared to placebo. Apixaban appears to have a more favorable safety profile compared to other therapies.
dc.description.peer-review.es_PE.fl_txt_mv Revisión por pares
description Diana.sobieraj@hhchealth.org
publishDate 2015
dc.date.accessioned.es_PE.fl_str_mv 2015-03-10T20:19:07Z
dc.date.available.es_PE.fl_str_mv 2015-03-10T20:19:07Z
dc.date.issued.fl_str_mv 2015-03-09
dc.type.es_PE.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.citation.es_PE.fl_str_mv 1. Sobieraj DM, Coleman CI, Pasupuleti V, Deshpande A, Kaw R, Hernandez A V. Comparative efficacy and safety of anticoagulants and aspirin for extended treatment of venous thromboembolism: A network meta-analysis. Thromb Res [Internet]. Elsevier B.V.; 2015; Available from: http://linkinghub.elsevier.com/retrieve/pii/S0049384815001048
dc.identifier.issn.es_PE.fl_str_mv 0049-3848
dc.identifier.doi.es_PE.fl_str_mv 10.1016/j.thromres.2015.02.032
dc.identifier.uri.es_PE.fl_str_mv http://hdl.handle.net/10757/346496
dc.identifier.journal.es_PE.fl_str_mv Thrombosis Research
identifier_str_mv 1. Sobieraj DM, Coleman CI, Pasupuleti V, Deshpande A, Kaw R, Hernandez A V. Comparative efficacy and safety of anticoagulants and aspirin for extended treatment of venous thromboembolism: A network meta-analysis. Thromb Res [Internet]. Elsevier B.V.; 2015; Available from: http://linkinghub.elsevier.com/retrieve/pii/S0049384815001048
0049-3848
10.1016/j.thromres.2015.02.032
Thrombosis Research
url http://hdl.handle.net/10757/346496
dc.language.iso.es_PE.fl_str_mv eng
language eng
dc.relation.url.es_PE.fl_str_mv http://www.thrombosisresearch.com/article/S0049-3848%2815%2900104-8/abstract
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dc.publisher.es_PE.fl_str_mv Elsevier B.V.
dc.source.es_PE.fl_str_mv Universidad Peruana de Ciencias Aplicadas (UPC)
Repositorio Académico - UPC
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