Most Treatment Strategies for Venous Thromboembolism Are Similarly Effective.

[Argirios Argiriou]

September 25, 2014

Most Treatment Strategies for Venous Thromboembolism Are Similarly Effective.

Thomas L. Schwenk, MD reviewing Castellucci LA et al. JAMA 2014 Sep 17.
Rivaroxaban and apixaban probably confer the lowest risks for major bleeding.

For many years, unfractionated heparin (UFH) followed by vitamin K antagonists  was the standard treatment for patients with deep venous thrombosis or pulmonary embolism. More recently, low-molecular-weight heparin (LMWH) combined with vitamin K antagonists has become the most common choice, but other options include fondaparinux plus a vitamin K antagonist; edoxaban (submitted to the FDA, but not yet approved) or dabigatran (Pradaxa) combined with LMWH; orrivaroxaban (Xarelto), apixaban (Eliquis), or LMWH alone.

In a systematic review, researchers examined the safety and efficacy of these treatment strategies in 45 randomized controlled trials (durations, generally 3–6 months) with nearly 45,000 patients. Network meta-analysis techniques were used to compare all regimens with the LMWH–vitamin K antagonist combination. All treatment options, except the UFH–vitamin K antagonist combination, were similarly effective: The UFH–vitamin K antagonist combination was associated with about 40% greater relative risk for venous thromboembolism (VTE) recurrence (1.8% vs. 1.3%). Incidences of major bleeding were 0.5% and 0.3% with rivaroxaban and apixaban, respectively, compared with 0.9% for the LMWH–vitamin K antagonist combination.

COMMENT

These results are a starting point for making clinical decisions about the best treatment strategy for patients with VTE. However, many factors, including cost, monitoring, and patient comorbidities (such as severe renal failure) must be weighed.


CITATION(S):

Castellucci LA et al. Clinical and safety outcomes associated with treatment of acute venous thromboembolism: A systematic review and meta-analysis. JAMA 2014 Sep 17; 312:1122. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

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[Argirios Argiriou]

Safety of Direct-Acting Oral Anticoagulants vs. Warfarin for Venous Thromboembolism

Paul S. Mueller, MD, MPH, FACP reviewing Jun M et al. BMJ 2017 Oct 17. 

Risks for major bleeding and all-cause death within 90 days were similar.


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