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DOACs Versus VKAs in Older Adults Treated for Acute Venous Thromboembolism: Systematic Review and Meta-Analysis

Rahul Chaudhary1, Sandeep Pagali1, Jalaj Garg2

  • 1Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Journal of the American Geriatrics Society
|May 23, 2020
PubMed

Insights

Direct-acting oral anticoagulants (DOACs) show improved efficacy in treating venous thromboembolism (VTE) in older adults compared to vitamin K antagonists (VKAs). Safety outcomes were similar, suggesting DOACs are a beneficial option for this population.

Area of Science:

  • Cardiology
  • Geriatrics
  • Pharmacology

Background:

  • Venous thromboembolism (VTE) affects older adults, a population with limited data on direct-acting oral anticoagulants (DOACs).
  • Four DOACs are FDA-approved for VTE treatment, but their efficacy and safety in individuals aged 75 years and older require further investigation.

Purpose of the Study:

  • To compare the efficacy and safety of DOACs versus vitamin K antagonists (VKAs) for VTE treatment in older adults (≥75 years).
  • To assess the combined endpoint of recurrent VTE, VTE-related deaths, and bleeding events in this patient group.

Main Methods:

  • A systematic literature search was conducted across multiple databases (Medline, Embase, Web of Science, etc.) for relevant randomized controlled trials.
  • Meta-analysis was performed using a random effects model to pool data on efficacy (recurrent VTE and related deaths) and safety (bleeding events).

Main Results:

  • Six trials with 3,665 patients aged ≥75 years were included.
  • DOACs demonstrated improved efficacy over VKAs (RR = 0.56; 95% CI = 0.38-0.82) with no statistically significant difference in safety outcomes (RR = 0.77; 95% CI = 0.56-1.05).
  • Data for bleeding events were unavailable for dabigatran.

Conclusions:

  • DOACs appear to enhance outcomes for older adults with VTE by reducing recurrent VTE and related deaths compared to VKAs.
  • Bleeding risk remains similar between DOACs and VKAs in this elderly population.
Abstract

Keywords:
direct-acting anticoagulantsolder adultssystematic reviewthrombosisvenous thromboembolism

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