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Efficacy and Safety of Direct Oral Anticoagulants for Acute Treatment of Venous Thromboembolism in Older Adults: A Network Meta-Analysis of Randomised Controlled Trials.
Pessôa, Renato Luís; Kessler, Vitor Germano; Becker, Gabriel Goerck; Garcia, Gabriel Moretti; Duarte Araldi, Pedro Victor; Aver, Pedro Verza.
Afiliación
  • Pessôa RL; Medical School, Universidade do Vale do Taquari, Lajeado, Brazil.
  • Kessler VG; Medical School, Universidade do Vale do Taquari, Lajeado, Brazil.
  • Becker GG; Medical School, Universidade do Vale do Taquari, Lajeado, Brazil.
  • Garcia GM; Medical School, Universidade do Vale do Taquari, Lajeado, Brazil.
  • Duarte Araldi PV; Medical School, Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Ijuí, Brazil.
  • Aver PV; Medical School, Universidade do Contestado, Mafra, Brazil.
Vasc Endovascular Surg ; 58(6): 633-639, 2024 Aug.
Article en En | MEDLINE | ID: mdl-38706248
ABSTRACT

OBJECTIVE:

This systematic review and network meta-analysis aimed to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) in adults aged 75 and over undergoing acute venous thromboembolism (VTE) treatment.

METHODS:

PubMed, Embase and the CENTRAL were searched up to 25 December 2023. The incidence of VTE recurrence and bleeding events was assessed. Employing a frequentist network meta-analysis approach, interventions not directly compared could be indirectly assessed through the 95% confidence interval (CI), enhancing the interpretability of the search results. The surface under the cumulative ranking curves (SUCRA) was utilized to generate the relative ranking probabilities for each group.

RESULTS:

Our study, analysing 6 randomised controlled trials with 3665 patients, compares direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in adults aged 75 and over with acute venous thromboembolism. Edoxaban reduces VTE recurrence risk compared with VKAs (risk ratio [RR] .50, 95% CI 0.27 - .95), while apixaban significantly decreases bleeding risk compared with VKAs (RR .23, 95% CI 0.08 - .69), edoxaban (RR .28, 95% CI 0.09 - .86) and rivaroxaban (RR .28, 95% CI 0.09 - .86). Despite low overall evidence quality, apixaban consistently ranks highest for both efficacy and safety. Findings underscore the nuanced efficacy-safety balance in this population, emphasizing cautious interpretation due to evidence limitations.

CONCLUSION:

Apixaban emerges as a favourable choice for acute VTE treatment in the elderly, displaying reduced bleeding risk compared to other treatments while maintaining comparable efficacy. Future studies should explore diverse anticoagulants efficacy and safety in older populations. Additionally, clinical prediction models tailored to geriatric cohorts are crucial for guiding treatment duration decisions.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Recurrencia / Ensayos Clínicos Controlados Aleatorios como Asunto / Tromboembolia Venosa / Inhibidores del Factor Xa / Metaanálisis en Red / Hemorragia Límite: Aged / Aged80 / Female / Humans / Male Idioma: En Revista: Vasc Endovascular Surg Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Brasil Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Recurrencia / Ensayos Clínicos Controlados Aleatorios como Asunto / Tromboembolia Venosa / Inhibidores del Factor Xa / Metaanálisis en Red / Hemorragia Límite: Aged / Aged80 / Female / Humans / Male Idioma: En Revista: Vasc Endovascular Surg Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Brasil Pais de publicación: Estados Unidos