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. 2024 Dec 27.
doi: 10.1007/s10557-024-07654-1. Online ahead of print.

Comparative Safety and Efficacy of Non-vitamin K Antagonist Oral Anticoagulants (NOACs) Versus Warfarin in Deep Vein Thrombosis (DVT) Treatment: A Meta-analysis

Manwei Hao #  1 , Zhongchao Wang #  2 , Han Gao  2 , Haicheng Gao  3 , Zhihua Cheng  4
Affiliations

Comparative Safety and Efficacy of Non-vitamin K Antagonist Oral Anticoagulants (NOACs) Versus Warfarin in Deep Vein Thrombosis (DVT) Treatment: A Meta-analysis

Manwei Hao et al. Cardiovasc Drugs Ther. .

Abstract

Purpose: This meta-analysis aimed to conduct a systematic evaluation of the comparative efficacy and safety of new oral anticoagulants (NOACs) versus warfarin for the treatment of deep venous thrombosis (DVT).

Methods: A systematic computerized search of databases including PubMed, Medline, Web of Science, Embase, Cochrane Library, and www.

Clinicaltrials: gov . was performed to gather research on the efficacy and safety of NOACs versus warfarin in the treatment of DVT, encompassing all records from the inception of each database through September 2024. The discrete data were presented as odds ratios (ORs) with their corresponding 95% confidence intervals (CIs), and the meta-analysis was executed utilizing the Review Manager 5.4.1 and Stata 16 softwares.

Results: A comprehensive analysis of 16 studies encompassing 10,084 patients was conducted, with 6704 individuals in the experimental group receiving NOACs and 3380 in the control group treated with warfarin. The findings are as follows: (1) NOACs demonstrated enhanced treatment efficacy over warfarin, particularly in achieving vascular patency (OR = 1.57, 95% CI (1.09, 2.24), P = 0.01). (2) Regarding the incidence of major bleeding events (OR = 0.65, 95% CI (0.54, 0.78), P < 0.00001), other clinical adverse events-including pulmonary embolism, mortality, stroke, myocardial infarction and recurrent thrombosis (OR = 0.77, 95% CI (0.67, 0.88), P = 0.0002), and post-thrombotic syndrome (PTS) (OR = 0.62, 95% CI (0.47, 0.80), P = 0.0003); NOACs offered improved safety profiles in comparison to warfarin. Furthermore, subgroup analysis revealed that the preventive efficacy of NOACs against PTS improves with longer follow-up periods (P = 0.02).

Conclusion: NOACs have demonstrated superior efficacy and safety profiles in the treatment of DVT compared to traditional warfarin anticoagulant therapy.

Clinical trial registration: This project did not involve any clinical data collection; the data utilized were derived from articles published in PubMed.

Keywords: Deep vein thrombosis; Meta-analysis; New oral anticoagulant; Warfarin.

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Conflict of interest statement

Declarations. Ethics Approval: This manuscript presents a meta-analysis, which is a systematic review of existing literature and does not entail any ethical considerations or require ethical approval, as it does not involve the collection, analysis, or reporting of primary data from human or animal subjects. Consent to Participate: Written informed consent was obtained from all participants or their legal guardians prior to their inclusion in the study. Consent to Publish: All participants provided written informed consent for the publication of their data, including any potentially identifying or sensitive information. Competing Interests: The author has no relevant financial or non-financial interests to disclose.

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