Credit: CDC
A newly published meta-analysis suggests most anticoagulant therapies produce similar results in patients with venous thromboembolism (VTE).
Using data from 45 randomized trials, investigators compared 8 anticoagulation options and found that most were associated with similar rates of VTE recurrence and bleeding.
They did find that unfractionated heparin (UFH) plus a vitamin K antagonist (VKA) conferred the greatest risk of VTE recurrence.
And rivaroxaban and apixaban were associated with the lowest rates of bleeding.
Two treatments—apixaban and low-molecular-weight heparin (LMWH) plus edoxaban—had the highest probability of being the best therapy. And apixaban had the greatest probability of being the least harmful therapy.
Lana A. Castellucci, MD, of the Ottawa Hospital Research Institute in Ontario, Canada, and her colleagues reported these results in JAMA.
The team conducted this meta-analysis to compare the efficacy and safety of 8 anticoagulation options: rivaroxaban, apixaban, LMWH, LMWH plus dabigatran, LMWH plus edoxaban, LMWH plus a VKA, UFH plus a VKA, and fondaparinux plus a VKA.
A search of the medical literature revealed 45 randomized trials comparing treatment options for VTE. They included a total of 44,989 patients.
VTE recurrence
The investigators first compared the risk of VTE recurrence with LMWH-VKA to all other treatment strategies. They found that 6 of the other options were associated with a lower rate of VTE recurrence than LMWH-VKA.
The only exception was UFH-VKA. During 3 months of treatment, 1.84% of patients who received UFH-VKA had a VTE recurrence, compared to 1.30% of patients treated with LMWH-VKA.
When the investigators used UFH-VKA as the comparator, they found that LMWH-VKA and LMWH alone were the only treatments associated with a reduction in recurrent VTE.
Stepwise comparisons of the remaining treatment strategies did not reveal significant differences in VTE recurrence.
However, the investigators found that LMWH-edoxaban and apixaban had the greatest probability of being the best therapy—at 33.1% and 31.6%, respectively.
Bleeding risk
Compared with LMWH-VKA, rivaroxaban and apixaban were associated with the lowest bleeding risk. The incidence of major bleeding during 3 months of anticoagulation was 0.49% for rivaroxaban, 0.28% for apixaban, and 0.89% for LMWH-VKA.
For all other treatments, the risk of bleeding did not differ significantly from the risk associated with LMWH-VKA.
Additional pairwise comparisons showed that rivaroxaban, apixaban, or both were associated with the lowest bleeding rates compared with UFH-VKA, fondaparinux-VKA, LMWH-dabigatran, and LMWH-edoxaban.
Apixaban was associated with the greatest probability of being the least harmful therapy (88.9%).
Considering these results together, Dr Castellucci and her colleagues concluded that most of the VTE treatments studied elicited comparable safety and efficacy outcomes.
However, UFH-VKA may be the least effective strategy for managing VTE, and rivaroxaban and apixaban may be associated with the lowest risk of bleeding.
