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Meta-Analysis
. 2022 Mar 14;22(1):105.
doi: 10.1186/s12872-022-02550-8.

Non-vitamin K antagonist oral anticoagulants in venous thromboembolism patients: a meta-analysis of real-world studies

Zhi-Yan Liu  1 , Han-Xu Zhang  1   2 , Ling-Yue Ma  1 , Guang-Yan Mu  1 , Qiu-Fen Xie  1 , Shuang Zhou  1 , Zi-Ning Wang  1 , Zhe Wang  1 , Kun Hu  1 , Qian Xiang  3 , Yi-Min Cui  4   5
Affiliations
Meta-Analysis

Non-vitamin K antagonist oral anticoagulants in venous thromboembolism patients: a meta-analysis of real-world studies

Zhi-Yan Liu et al. BMC Cardiovasc Disord. .

Abstract

Background: The real-world studies on recurrent venous thromboembolism (VTE) and bleeding events of non-vitamin K antagonist oral anticoagulants (NOACs) in VTE patients have reported conflicting findings. Our study aimed to provide the direct comparison evidence of different NOACs for VTE patients in clinical practice settings.

Methods: Search of the medical literature was conducted using PubMed, Web of Science, EMBASE, Clinical Trials.gov, and the Cochrane Library from inception to March 22, 2021. Among the 19,996 citations retrieved, a total of 63,144 patients from 6 studies were analyzed. Clinical outcomes included recurrent VTE, death, and different bleeding events.

Results: Adjusted hazard ratio (HR) analysis suggested that apixaban had significant lower bleeding riskthan rivaroxaban (major, minor and any bleeding: HR = 0.61, 0.56, 0.70; p = 0.008, < 0.0001, 0.006, respectively), but no statistics difference found in recurrent VTE events (HR = 1.02, 95% confidence interval (CI) 0.71-1.47, p = 0.93). There was no significant difference of major bleeding between dabigatran and rivaroxaban (odds ratios (OR) = 0.41, 95% CI 0.09-1.90, p = 0.25), apixaban and dabigatran (OR 0.64, 95% CI 0.15-2.72, p = 0.83). No significant difference was found in the comparison of edoxaban and other NOACs in VTE recurrence, major bleeding and composite outcome.

Conclusions: In the prevention of bleeding events, apixaban was associated with a lower risk than rivaroxaban, but equivalent efficacy for different NOACs in prevention of recurrent VTE. Evidence generated from the meta-analysis based on real-world data can help to guide selection between apixaban and rivaroxaban in routine clinical practice.

Trial registration: This systematic review and meta-analysis were conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis and Meta-analysis of Observational Studies in Epidemiology statements and was registered with PROSPERO (CRD42019140553).

Keywords: Clinical outcomes; Direct comparison; Meta-analysis; NOACs; VTE.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A flow diagram of study identification and selection
Fig. 2
Fig. 2
Comparison of apixaban and rivaroxaban in different clinical outcomes
Fig. 3
Fig. 3
Comparison of dabigatran and rivaroxaban in different clinical outcomes
Fig. 4
Fig. 4
Comparison of edoxaban and other NOACs in different clinical outcomes
See this image and copyright information in PMC

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