Contemporary Meta-Analysis of Extended Direct-Acting Oral Anticoagulant Thromboprophylaxis to Prevent Venous Thromboembolism - 29/08/20
, Ahmed Abdel-Latif, MD, PhD, Meenakshi Bhalla, MD, Khaled Ziada, MD, Susan S. Smyth, MD, PhDAbstract |
Background |
Medically ill patients remain at risk of venous thromboembolism for up to 6 weeks after hospital discharge due to factors such as immobilization and inflammation.
Methods |
We conducted a meta-analysis and systematic review of Phase III randomized controlled trials comparing extended use of direct oral anticoagulation (DOAC) post discharge for venous thromboembolism prophylaxis with placebo.
Results |
The primary efficacy outcome (composite of venous thromboembolism and mortality) occurred in 373/13,099 patients in the DOAC group (2.9%) and 477/13,309 patients in the placebo group (3.6%), with an odds ratio (OR) of 0.79 (95% confidence interval [CI], 0.69-0.91). The secondary efficacy outcome (nonfatal symptomatic venous thromboembolism) occurred in 75/15,573 patients in the DOAC group (0.48%) and 120/15,599 in the placebo group (0.77%) with an OR of 0.62 (95% CI, 0.47-0.83). The primary safety outcome (major bleeding) occurred in 90/15,474 patients in the DOAC group (0.58%) and in 47/15,418 patients in the placebo group (0.3%) with an OR of 1.92 (95% CI, 1.35-2.73). The secondary safety (clinically relevant nonmajor bleeding) outcome occurred in 333/15,474 patients in the DOAC group (2.2%) and 191/15,418 patients in the placebo group (1.2%) with an OR of 1.75 (95% CI, 1.46-2.1). The extended use of venous thromboembolism prophylaxis post discharge results in decreased venous thromboembolism events but increased bleeding risk. Our cost-effective analysis of extended DOAC use vs placebo showed superiority of the DOAC group.
Conclusion |
In conclusion, given the mortality benefit and cost benefit, extended thromboprophylaxis is a beneficial strategy to efficiently reduce the risk of venous thromboembolism.
Le texte complet de cet article est disponible en PDF.Keywords : Direct-acting oral anticoagulants, Medical illness hospitalization, Meta-analysis, Thromboprophylaxis
Plan
| Funding: VB's research time is funded by the National Institutes of Health's funded KL2 program at the University of Kentucky's Center for Clinical and Translational Science (CCTS) - 5KL2TR001996-02, Lexington, Ky. |
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| Conflict of Interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. |
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| Authorship: All authors have seen and approved the final version of the manuscript being submitted. They had access to the data and a role in writing and editing the manuscript. They warrant that the article is the authors' original work, hasn't received prior publication, and isn't under consideration for publication elsewhere. |
Vol 133 - N° 9
P. 1074 - septembre 2020 Retour au numéro
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