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In VTE patients, Edoxaban is effective to prevent both recurrence and major bleeding, and Apixaban is the best anticoagulant to control clinically relevant bleeding.
In a network meta-analysis of approximately 22,000 patients, there was no marked difference in recurrence related to novel oral anticoagulants (NOACs) when compared with standard-intensity Warfarin, and NOACs were related to a lower risk of bleeding in venous thromboembolism (VTE)-affected people. For the prolonged therapy of VTE, a wide array of anticoagulants are available. However, there is limited information on which medication is the most efficient and safe. For resolving this uncertainty, a study was done.
Randomised controlled trials (RCTs) that compared the safety and effectiveness of anticoagulants for adults with VTE against other anticoagulants or placebo were explored. In 12 papers, 13 eligible RCTs were found. Except for Aspirin, all of the pooled hazard ratios (HR) and 95% credible intervals (CrI) were determined using comparisons to standard-intensity Warfarin. Edoxaban was ranked first among the NOACs, which were comparable to standard-intensity Warfarin in evading recurrence (HR = 0.99). With the exception of Rivaroxaban, all NOACs prevented bleeding episodes better than standard-intensity Warfarin.
For controlling major bleeding (HR = 0.07) as well as clinically relevant non-major bleeding (CRNMB, HR = 0.30), Apixaban was ranked first and was deemed to be safer when compared to other NOACs. Among the NOACs, Edoxaban was ranked second for control of major bleeding (HR = 0.44) while Dabigatran was ranked second for control of CRNMB (HR = 0.54). NOACs were linked to a decreased incidence of bleeding episodes. But, there were no vital differences in recurrence between standard-intensity Warfarin and NOACs. Major bleeding and VTE recurrence were successfully averted by Edoxaban, while Apixaban was the most effective anticoagulant to control bleeding events.
Journal of Cardiovascular Development and Disease
Clinical and Safety Outcomes Associated with Extended Treatment of Venous Thromboembolism: A Network Meta-Analysis
Zhiqiang Liu et al.
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