Efficacy and safety of antithrombotic therapy for preventing and treating pediatric thromboembolic disease: a systematic review

Abstract

This review used traditional and network meta-analyses (NMA) to conduct a comprehensive study of antithrombotic therapies in children with thromboembolic disease. We searched the PubMed, Embase, Cochrane Library, Web of Science and ClinicalTrials.gov databases from their inception to 26 February, 2023. And we finally included 16 randomized controlled trials. In the prevention of thromboembolic events (TEs), the use of anticoagulants had a low risk of TEs (relative risk (RR) 0.73, 95% CI 0.56 to 0.94) and a high risk of minor bleeding (RR 1.43, 95% CI 1.09 to 1.86) compared with no anticoagulants. In the treatment of TEs, direct oral anticoagulants (DOACs) were not inferior to standard anticoagulation in terms of efficacy and safety outcomes. In NMA, rivaroxaban and apixaban showed the lowest risk for TEs and major or clinically relevant nonmajor bleeding. According to the overall assessment of efficacy and safety, dabigatran may be the best choice for children with thromboembolic disease. The results of our study will provide references and suggestions for clinical drug selection.

Figure 1

Flowchart of the literature search and the study selection process.

Figure 2

Forest plot showing the efficacy and safety outcomes between patients taking anticoagulants and those taking no anticoagulants in the prevention group. Note: VKA vitamin K antagonist, LMWH low-molecular-weight heparin, DOACs direct oral anticoagulants.

Figure 3

Forest plot showing the efficacy and safety outcomes between patients taking DOACs and those taking SAC in the treatment group. Note: DOACs direct oral anticoagulants, SAC standard anticoagulation.

Figure 4

Forest plot showing the safety outcome (CRB) of DOACs versus SAC in NMA of RCTs. Note: CRB major or clinically relevant nonmajor bleeding, NMA network meta-analysis, RCTs randomized controlled trials, RR risk ratio, CI confidence interval, SAC standard anticoagulation.

Figure 5

Ranking plot for major or clinically relevant nonmajor bleeding. Note: SAC standard anticoagulation, SUCRA surface under the cumulative ranking curves. Higher SUCRA number indicates lower risk of events.