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Extended Anticoagulation for VTE: A Systematic Review and Meta-Analysis.

Vicky Mai1, Charles-Antoine Guay1, Laurie Perreault1

  • 1Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Laval University, Québec City, QC, Canada.

Chest
|June 9, 2019
PubMed
Summary

Direct oral anticoagulants (DOACs) significantly reduce overall and VTE-related mortality in extended anticoagulation for venous thromboembolism (VTE). Unlike vitamin K antagonists (VKAs), DOACs offer improved net clinical benefit and survival.

Keywords:
VTEdirect oral anticoagulantextended anticoagulationmortalityvitamin K antagonist

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Area of Science:

  • Cardiology
  • Hematology
  • Pharmacology

Background:

  • Extended anticoagulation for VTE is crucial for secondary prevention.
  • The comparative efficacy and safety of DOACs and VKAs for long-term VTE management are not well-established.
  • Survival benefits of extended anticoagulation strategies require further investigation.

Purpose of the Study:

  • To evaluate the impact of DOACs and VKAs on overall mortality in patients requiring extended anticoagulation for VTE.
  • To compare the effects of DOACs and VKAs on VTE recurrence and safety profiles.
  • To assess the net clinical benefit of DOACs versus VKAs in VTE secondary prevention.

Main Methods:

  • A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted.
  • Searched PubMed, EMBASE, and Cochrane Library from January 1990 to September 2018.
  • Included 16 RCTs involving 12,458 patients comparing extended anticoagulants with placebo for VTE secondary prevention.

Main Results:

  • DOACs significantly reduced overall mortality (RR, 0.48) and VTE-related mortality (RR, 0.36) compared to placebo.
  • VKAs did not show a significant reduction in overall mortality (P > .50).
  • Both DOACs and VKAs effectively prevented VTE recurrence, but VKAs were associated with increased major bleeding risk (RR, 2.67), leading to a superior net clinical benefit for DOACs.

Conclusions:

  • Extended anticoagulation with DOACs is associated with a significant reduction in overall mortality.
  • DOACs demonstrate a favorable safety and efficacy profile for long-term VTE management compared to VKAs.
  • DOACs represent a valuable option for secondary prevention in VTE patients, offering survival benefits and improved net clinical outcomes.