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Qiu YH, Yang Z, Yang FJ, Su X, Chen BC, Ni HZ. Prophylactic dose of rivaroxaban versus warfarin for the treatment of isolated calf muscle vein thrombosis: a retrospective propensity score-matched analysis. Ann Vasc Surg 2024:S0890-5096(24)00435-7. [PMID: 39025209 DOI: 10.1016/j.avsg.2024.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/14/2024] [Accepted: 06/10/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Prophylactic dose of rivaroxaban is often used in treatment of isolated calf muscle vein thrombosis (ICMVT), nevertheless, its effect is less reported. This study aims to evaluate short-term outcomes in patients with ICMVT who received prophylactic dose of rivaroxaban or warfarin therapy. METHODS A retrospective analysis of 472 ICMVT patients who received two different treatment regimens was undertaken. Propensity score matching method was used to balance the confounding effect of baseline clinical data. Chi-squared test and logistic regression analysis were used to compare outcomes (venous thromboembolism events, bleeding events, complete clot resolution) according to the type of treatment regimens before and after propensity score matching. Univariate and multivariable analysis were used to investigate risk factors for incomplete clot resolution of ICMVT after propensity score matching. RESULTS 242 ICMVT patients received prophylactic dose of rivaroxaban (rivaroxaban group, RG), and 230 received warfarin (warfarin group, WG). After propensity score matching, 156 patients were included in each group; Venous thromboembolism (VTE) events occurred in 14 (9.0%) patients in the RG and 10 (6.4%) in the WG (P = 0.395); No major bleeding events occurred in each group, and clinically relevant non-major bleeding events occurred in 5 (3.2%) patients in the RG and 10 (6.4%) in the WG (P = 0.186); Complete clot resolution at 3 months occurred in 80 (51.3%) patients in the RG and 100 (64.1%) in the WG (P = 0.022). Logistic regression analysis showed that there were no significant differences between RG and WG in VTE events (odds ratio 1.439, 95% confidence interval 0.619 to 3.347, P = 0.397) and clinically relevant non-major bleeding events (odds ratio 0.483, 95% confidence interval 0.161 to 1.449, P = 0.194); it revealed that complete clot resolution rate at 3 months was different in the two groups (odds ratio 0.589, 95% confidence interval 0.375 to 0.928, P = 0.022). Treatment regimens (prophylactic dose of rivaroxaban), thrombosis (maximum diameter >7 mm) and risk factors for VTE (non-surgery risk factors, mainly referring to active malignancy) were risk factors for incomplete clot resolution of ICMVT (P < 0.05). CONCLUSIONS In this retrospective study with a short-term follow-up, ICMVT patients who received prophylactic dose of rivaroxaban had no significant differences in VTE and bleeding events compared to those who received warfarin therapy (the overall INR > 2.0 for >50% of the time); but it was not conducive to complete clot resolution.
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Affiliation(s)
- Yi-Hui Qiu
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhe Yang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Fa-Jing Yang
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiang Su
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bi-Cheng Chen
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Hai-Zhen Ni
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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Wu S, Wang H, Li C, Tao J, Zhu X, Dai H, Duan H, Hu T, Li M, Qu F, Wei Y, Wang C, Zhang J. Efficacy and safety of direct oral anticoagulants for preventing venous thromboembolism in hospitalized cancer patients: a national multicenter retrospective cohort study. Front Pharmacol 2024; 15:1373635. [PMID: 39035988 PMCID: PMC11257898 DOI: 10.3389/fphar.2024.1373635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 06/17/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction Studies on the use of direct oral anticoagulants (DOACs) for preventing venous thromboembolism (VTE) in hospitalized cancer patients are lacking. Therefore, we conducted a multicenter retrospective cohort study to evaluate the efficacy and safety of DOACs versus low-molecular-weight heparin (LMWH) for the primary prevention of VTE in hospitalized cancer patients. Methods Clinical outcomes included thrombosis, VTE, other thrombosis, all bleeding, major bleeding, nonmajor bleeding, and all-cause death. A 1:1 cohort of rivaroxaban and LMWH patients was created by propensity score matching. Results A total of 2,385 cancer patients were included in this study. During the 3-month follow-up period, 129 (5.4%) thrombosis events occurred, 63 (2.7%) of which were VTEs and 66 (2.8%) of which were other thrombosis events. All bleeding occurred in 163 (6.8%) patients, 68 (2.9%) had major bleeding, and 95 (4.0%) had nonmajor bleeding. All-cause deaths occurred in 113 (4.7%) patients. After adjusting for various confounders, the incidence of thrombosis and other thromboses was significantly lower in the rivaroxaban group than in the LMWH group [OR 0.543, 95% CI (0.343-0.859), p = 0.009; OR 0.461, 95% CI (0.241-0.883), p = 0.020]. There were no significant differences in incidence of VTE, total bleeding, major bleeding, nonmajor bleeding, or all-cause death. Conclusion In oncology patients receiving thromboprophylaxis, rivaroxaban has a lower incidence of thrombosis and other thrombosis and a similar incidence of VTE as LMWH and does not increase the risk of bleeding. Rivaroxaban may be an attractive alternative to LMWH for preventing VTE in hospitalized cancer patients.
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Affiliation(s)
- Shuyi Wu
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Haiping Wang
- Department of Pharmacy, The Second Hospital of Longyan Fujian Province, Longyan, China
| | - Chunbao Li
- Department of Pharmacy, Jinjiang Municipal Hospital (Shanghai Sixth People’s Hospital Fujian Campus), Quanzhou, China
| | - Jingjing Tao
- Department of Pharmacy, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoli Zhu
- Department of Pharmacy, Red Cross Hospital of Yulin City, Yulin, China
| | - Hengfen Dai
- Department of Pharmacy, Affiliated Fuzhou First General Hospital of Fujian Medical University, Fuzhou, China
| | - Hongfan Duan
- Department of Pharmacy, The Second People’s Hospital of Baoshan City, Baoshan, China
| | - Tian Hu
- Department of Pharmacy, 3201 Hospital of Xi’an Jiaotong University Health Science Center, Hanzhong, Shaanxi, China
| | - Miao Li
- Department of Pharmacy, The Second Hospital of Dalian Medical University Pharmacy Department Dalian, Dalian, China
| | - Fenfen Qu
- Department of Pharmacy, Yuncheng Central Hospital, Yuncheng, China
| | - Yun Wei
- Department of Pharmacy, Hunan Aerospace Hospital, Changsha, China
| | - Chunhua Wang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jinhua Zhang
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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Papakonstantinou PE, Kalogera V, Charitos D, Polyzos D, Benia D, Batsouli A, Lampropoulos K, Xydonas S, Gupta D, Lip GYH. When anticoagulation management in atrial fibrillation becomes difficult: Focus on chronic kidney disease, coagulation disorders, and cancer. Blood Rev 2024; 65:101171. [PMID: 38310007 DOI: 10.1016/j.blre.2024.101171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 02/05/2024]
Abstract
Anticoagulation therapy (AT) is fundamental in atrial fibrillation (AF) treatment but poses challenges in implementation, especially in AF populations with elevated thromboembolic and bleeding risks. Current guidelines emphasize the need to estimate and balance thrombosis and bleeding risks for all potential candidates of antithrombotic therapy. However, administering oral AT raises concerns in specific populations, such as those with chronic kidney disease (CKD), coagulation disorders, and cancer due to lack of robust data. These groups, excluded from large direct oral anticoagulants trials, rely on observational studies, prompting physicians to adopt individualized management strategies based on case-specific evaluations. The scarcity of evidence and specific guidelines underline the need for a tailored approach, emphasizing regular reassessment of risk factors and anticoagulation drug doses. This narrative review aims to summarize evidence and recommendations for challenging AF clinical scenarios, particularly in the long-term management of AT for patients with CKD, coagulation disorders, and cancer.
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Affiliation(s)
| | - Vasiliki Kalogera
- Third Cardiology Department, School of Medicine, National and Kapodistrian University of Athens, "Sotiria" Chest Hospital, Mesogeion Ave 152, 11527 Athens, Greece
| | - Dimitrios Charitos
- First Cardiology Department, Evangelismos Hospital, Ipsilantou 45-47, 106 76 Athens, Greece
| | - Dimitrios Polyzos
- Second Cardiology Department, Evangelismos Hospital, Ipsilantou 45-47, 106 76 Athens, Greece
| | - Dimitra Benia
- Cardiology Department, General Hospital-Health Center of Kithira, Aroniadika, 80200 Kithira Island, Greece
| | - Athina Batsouli
- Second Cardiology Department, Evangelismos Hospital, Ipsilantou 45-47, 106 76 Athens, Greece
| | - Konstantinos Lampropoulos
- Second Cardiology Department, Evangelismos Hospital, Ipsilantou 45-47, 106 76 Athens, Greece; School of Medicine, European University of Cyprus, Diogenous 6, 2404 Egkomi, Cyprus
| | - Sotirios Xydonas
- Second Cardiology Department, Evangelismos Hospital, Ipsilantou 45-47, 106 76 Athens, Greece
| | - Dhiraj Gupta
- Department of Cardiology, Liverpool Heart and Chest Hospital, L14 3PE Liverpool, United Kingdom.
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Thomas Dr., L14 3PE Liverpool, United Kingdom; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Selma Lagerløfs Vej 249, 9260 Gistrup, Aalborg, Denmark.
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Wu S, Guan C, Chang S, Wang C, Zhang J. Comparison of the Efficacy and Safety of Rivaroxaban and Low Molecular Heparin in Preventing Venous Thromboembolism in Inpatient Cancer Patients. Ann Pharmacother 2024; 58:214-222. [PMID: 37312538 DOI: 10.1177/10600280231178335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND There are few studies on using rivaroxaban and low molecular heparin (LMWH) to prevent venous thromboembolism (VTE) in hospitalized cancer patients. OBJECTIVE We conducted a retrospective study to evaluate the efficacy and safety of rivaroxaban versus LMWH for the primary prevention of VTE in inpatient cancer patients. METHODS Information on patients was collected through 6-month follow-up and medical record inquiries. Clinical outcomes included VTE, total bleeding, thrombosis, major bleeding, minor bleeding, all-cause death, and a composite endpoint of bleeding, thrombosis, and death. RESULTS A total of 602 hospitalized cancer patients were included in this study. During 6 months of follow-up, there were 26 VTE events (8.6%), 42 total bleeding events (7.0%), 62 all-cause deaths (10.3%), and 140 composite endpoints (23.3%). After adjusting for various confounding factors, there were no significant differences between the rivaroxaban and LMWH for VTE events (OR = 0.851, 95% CI [0.387-1.872], P=0.688), total bleeding (OR = 1.690, 95% CI [0.768-3.719], P = 0.192], thrombosis events (OR = 0.919, 95% CI [0.520-1.624], P = 0.772], major bleeding (OR = 0.276, 95% CI [0.037-2.059], P = 0.209), all-cause death (OR = 0.994, 95% CI [0.492-2.009], P = 0.987), and composite endpoints (OR = 0.994, 95% CI [0.492-2.009], P = 0.987), while minor bleeding (OR = 3.661 95% CI [1.000-7.083], P = 0.050) was significantly higher in the rivaroxaban than in the LMWH. CONCLUSIONS AND RELEVANCE In thromboprophylaxis in inpatient cancer patients, rivaroxaban has a similar rate of VTE and bleeding events as LMWH. Our results may provide a reference for the clinical use of rivaroxaban to prevent VTE in hospitalized cancer patients.
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Affiliation(s)
- Shuyi Wu
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Chengfu Guan
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Sijie Chang
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Chunhua Wang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jinhua Zhang
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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Tsiachris D, Papakonstantinou PE, Doundoulakis I, Tsioufis P, Botis M, Dimitriadis K, Leontsinis I, Kordalis A, Antoniou CK, Mantzouranis E, Iliakis P, Vlachakis PK, Gatzoulis KA, Tsioufis K. Anticoagulation Status and Left Atrial Appendage Occlusion Indications in Hospitalized Cardiology Patients with Atrial Fibrillation: A Hellenic Cardiorenal Morbidity Snapshot (HECMOS) Sub-Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1881. [PMID: 37893599 PMCID: PMC10608124 DOI: 10.3390/medicina59101881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/21/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: The proper use of oral anticoagulants is crucial in the management of non-valvular atrial fibrillation (AF) patients. Left atrial appendage closure (LAAC) may be considered for stroke prevention in patients with AF and contraindications for long-term anticoagulant treatment. We aimed to assess anticoagulation status and LAAC indications in patients with AF from the HECMOS (Hellenic Cardiorenal Morbidity Snapshot) survey. Materials and Methods: The HECMOS was a nationwide snapshot survey of cardiorenal morbidity in hospitalized cardiology patients. HECMOS used an electronic platform to collect demographic and clinically relevant information from all patients hospitalized on 3 March 2022 in 55 different cardiology departments. In this substudy, we included patients with known AF without mechanical prosthetic valves or moderate-to-severe mitral valve stenosis. Patients with prior stroke, previous major bleeding, poor adherence to anticoagulants, and end-stage renal disease were considered candidates for LAAC. Results: Two hundred fifty-six patients (mean age 76.6 ± 11.7, 148 males) were included in our analysis. Most of them (n = 159; 62%) suffered from persistent AF. The mean CHA2DS2-VASc score was 4.28 ± 1.7, while the mean HAS-BLED score was 1.47 ± 0.9. Three out of three patients with a a CHA2DS2-VASc score of 0 or 1 (female) were inappropriately anticoagulated. Sixteen out of eighteen patients with a CHA2DS2-VASc score 1 or 2 (if female) received anticoagulants. Thirty-one out of two hundred thirty-five patients with a CHA2DS2-VASc score > 1 or 2 (if female) were inappropriately not anticoagulated. Relative indications for LAAC were present in 68 patients with NVAF (63 had only one risk factor and 5 had two concurrent risk factors). In detail, 36 had a prior stroke, 17 patients had a history of major bleeding, 15 patients reported poor or no adherence to the anticoagulant therapy and 5 had an eGFR value < 15 mL/min/1.73 m2 for a total of 73 risk factors. Moreover, 33 had a HAS-BLED score ≥ 3. No LAAC treatment was recorded. Conclusions: Anticoagulation status was nearly optimal in a high-thromboembolic-risk population of cardiology patients who were mainly treated using NOACs. One out of four AF patients should be screened for LAAC.
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Affiliation(s)
- Dimitris Tsiachris
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
- Athens Heart Center, Athens Medical Center, 15125 Athens, Greece
| | - Panteleimon E. Papakonstantinou
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Ioannis Doundoulakis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Panagiotis Tsioufis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Michail Botis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Kyriakos Dimitriadis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Ioannis Leontsinis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Athanasios Kordalis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Christos-Konstantinos Antoniou
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
- Athens Heart Center, Athens Medical Center, 15125 Athens, Greece
| | - Emmanouil Mantzouranis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Panagiotis Iliakis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Panayotis K. Vlachakis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Konstantinos A. Gatzoulis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
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Wu S, Lv M, Chen J, Jiang S, Chen M, Fang Z, Zeng Z, Qian J, Xu W, Guan C, Zhang J. Direct oral anticoagulants for venous thromboembolism in cancer patients: a systematic review and network meta-analysis. Support Care Cancer 2022; 30:10407-10420. [PMID: 36318341 DOI: 10.1007/s00520-022-07433-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 10/24/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND The efficacy and safety of direct oral anticoagulants (DOACs), including dabigatran, apixaban, rivaroxaban, and edoxaban, for preventing and treating venous thromboembolism (VTE) in patients with cancer is unclear. METHODS We searched the PubMed, Embase, Web of Science, and Cochrane Library databases from the establishment to November 30, 2021. In the frequency-based network meta-analysis, the odds ratio with a 95% confidence interval was reported. The relative ranking probability of each group was generated based on the surface under the cumulative ranking curve (SUCRA). RESULTS We included 15 randomized controlled trials involving a total of 6162 patients. Apixaban reduced the risk of VTE compared with low-molecular heparin [OR = 0.53, 95% CI (0.32, 0.89)]. The efficacy of drugs was ranked from highest to lowest as follows: apixaban (SUCRA, 81.0), rivaroxaban (73.0), edoxaban (65.9), dabigatran (51.4), warfarin (30.8), and low-molecular-weight heparin (LMWH) (27.4). Edoxaban increased the risk of major bleeding compared with LMWH [OR = 1.83, 95% CI (1.04, 3.22)]. The safety of drugs was ranked from highest to lowest as follows: major bleeding-apixaban (SUCRA, 68.5), LMWH (55.1), rivaroxaban (53.0), warfarin (35.9), dabigatran (29.2), edoxaban (16.5) and clinically relevant non-major bleeding-LMWH (73.0), apixaban (57.8), edoxaban (45.8), rivaroxaban (35.3), and warfarin (10.8). CONCLUSIONS For preventing and treating VTE, in terms of VTE occurrence and major bleeding, apixaban had the lowest risk; in terms of clinically relevant non-major bleeding, LMWH had the lowest risk, followed by apixaban. Generally, apixaban is the most efficient and safest DOAC and presents better efficacy and relatively low bleeding risk among the VTE prevention and treatment drugs for patients with cancer.
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Affiliation(s)
- Shuyi Wu
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, #111 Daoshan Road, Fuzhou, 350001, China
| | - Meina Lv
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, #111 Daoshan Road, Fuzhou, 350001, China
| | - Jiana Chen
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, #111 Daoshan Road, Fuzhou, 350001, China
| | - Shaojun Jiang
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, #111 Daoshan Road, Fuzhou, 350001, China
| | - Mingrong Chen
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, #111 Daoshan Road, Fuzhou, 350001, China
| | - Zongwei Fang
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, #111 Daoshan Road, Fuzhou, 350001, China
| | - Zhiwei Zeng
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, #111 Daoshan Road, Fuzhou, 350001, China
| | - Jiafen Qian
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, #111 Daoshan Road, Fuzhou, 350001, China
| | - Wenlin Xu
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, #111 Daoshan Road, Fuzhou, 350001, China
| | - Chengfu Guan
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, #111 Daoshan Road, Fuzhou, 350001, China
| | - Jinhua Zhang
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, #111 Daoshan Road, Fuzhou, 350001, China.
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Mystakidi VC, Oikonomou E, Tousoulis D. Current Antithrombotic Therapy: Beyond Coronary Artery Disease. Curr Pharm Des 2020; 26:2683-2685. [DOI: 10.2174/138161282623200625103419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Vasiliki-Chara Mystakidi
- Department of Cardiology, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelos Oikonomou
- Department of Cardiology, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitris Tousoulis
- Department of Cardiology, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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