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Direct oral anticoagulants in patients with venous thromboembolism and thrombophilia: a systematic review and meta-analysis.
J Thromb Haemost. 2019 04; 17(4):645-656.JT

Abstract

Essentials We investigated direct oral anticoagulant (DOAC) use in venous thromboembolism and thrombophilia. A comprehensive search identified 10 studies, 8 of which were included in a meta-analysis. DOACs were overall safe and effective in patients with venous thromboembolism and thrombophilia. Efficacy/safety of DOACs was maintained in low-risk antiphospholipid syndrome patient subgroup.

SUMMARY:

Background Direct oral anticoagulants (DOACs) are increasingly used in acute and long-term treatment of venous thromboembolism (VTE). However, their role in management of thrombophilia-associated VTE is controversial. Methods Through a comprehensive search on MEDLINE, Cochrane Library, and Clinicaltrials.gov, we identified 10 eligible studies, 8 of which reporting data on 1994 thrombophilia patients were included in a random-effects meta-analysis. Eligible studies were phase 2 to 3 randomized controlled trials comparing DOACs to vitamin K antagonists (VKAs) in patients with VTE, including those with thrombophilia. Results Of eight studies included in meta-analysis, four evaluated rivaroxaban, three dabigatran, and one edoxaban. No results could be obtained on apixaban use. The rates of VTE recurrence (RR, 0.70; 95% CI, 0.34-1.44; I2 = 0%) and major/clinically relevant non-major bleeding events (RR, 0.92; 95% CI, 0.62-1.36; I2 = 23%) were similar between thrombophilia patients treated with DOACs compared to VKAs. Results were comparable to findings in patients without known thrombophilia: RR, 1.02; 95% CI, 0.80-1.30; I2 = 46% for VTE recurrence and RR, 0.72; 95% CI, 0.57-0.90; I2 = 84% for major/clinically relevant non-major bleeding events. Conclusions Rates of VTE recurrence and bleeding events were both low and comparable in patients with various thrombophilias receiving either treatment, suggesting that DOACs are an appropriate treatment option in this population. Due to limited data, it is unclear whether these findings apply to specific subgroups such as high-risk antiphospholipid syndrome, uncommon thrombophilias, or the use of apixaban.

Authors+Show Affiliations

Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.Winship Cancer Institute of Emory University, Atlanta, GA, USA.Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.Winship Cancer Institute of Emory University, Atlanta, GA, USA.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

30690830

Citation

Elsebaie, Maha A T., et al. "Direct Oral Anticoagulants in Patients With Venous Thromboembolism and Thrombophilia: a Systematic Review and Meta-analysis." Journal of Thrombosis and Haemostasis : JTH, vol. 17, no. 4, 2019, pp. 645-656.
Elsebaie MAT, van Es N, Langston A, et al. Direct oral anticoagulants in patients with venous thromboembolism and thrombophilia: a systematic review and meta-analysis. J Thromb Haemost. 2019;17(4):645-656.
Elsebaie, M. A. T., van Es, N., Langston, A., Büller, H. R., & Gaddh, M. (2019). Direct oral anticoagulants in patients with venous thromboembolism and thrombophilia: a systematic review and meta-analysis. Journal of Thrombosis and Haemostasis : JTH, 17(4), 645-656. https://doi.org/10.1111/jth.14398
Elsebaie MAT, et al. Direct Oral Anticoagulants in Patients With Venous Thromboembolism and Thrombophilia: a Systematic Review and Meta-analysis. J Thromb Haemost. 2019;17(4):645-656. PubMed PMID: 30690830.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Direct oral anticoagulants in patients with venous thromboembolism and thrombophilia: a systematic review and meta-analysis. AU - Elsebaie,Maha A T, AU - van Es,Nick, AU - Langston,Amelia, AU - Büller,Harry R, AU - Gaddh,Manila, Y1 - 2019/02/25/ PY - 2018/10/09/received PY - 2019/1/29/pubmed PY - 2020/4/14/medline PY - 2019/1/29/entrez KW - direct factor Xa inhibitors KW - direct oral anticoagulants KW - direct thrombin inhibitors KW - hypercoagulability KW - thrombophilia KW - venous thromboembolism SP - 645 EP - 656 JF - Journal of thrombosis and haemostasis : JTH JO - J. Thromb. Haemost. VL - 17 IS - 4 N2 - Essentials We investigated direct oral anticoagulant (DOAC) use in venous thromboembolism and thrombophilia. A comprehensive search identified 10 studies, 8 of which were included in a meta-analysis. DOACs were overall safe and effective in patients with venous thromboembolism and thrombophilia. Efficacy/safety of DOACs was maintained in low-risk antiphospholipid syndrome patient subgroup. SUMMARY: Background Direct oral anticoagulants (DOACs) are increasingly used in acute and long-term treatment of venous thromboembolism (VTE). However, their role in management of thrombophilia-associated VTE is controversial. Methods Through a comprehensive search on MEDLINE, Cochrane Library, and Clinicaltrials.gov, we identified 10 eligible studies, 8 of which reporting data on 1994 thrombophilia patients were included in a random-effects meta-analysis. Eligible studies were phase 2 to 3 randomized controlled trials comparing DOACs to vitamin K antagonists (VKAs) in patients with VTE, including those with thrombophilia. Results Of eight studies included in meta-analysis, four evaluated rivaroxaban, three dabigatran, and one edoxaban. No results could be obtained on apixaban use. The rates of VTE recurrence (RR, 0.70; 95% CI, 0.34-1.44; I2 = 0%) and major/clinically relevant non-major bleeding events (RR, 0.92; 95% CI, 0.62-1.36; I2 = 23%) were similar between thrombophilia patients treated with DOACs compared to VKAs. Results were comparable to findings in patients without known thrombophilia: RR, 1.02; 95% CI, 0.80-1.30; I2 = 46% for VTE recurrence and RR, 0.72; 95% CI, 0.57-0.90; I2 = 84% for major/clinically relevant non-major bleeding events. Conclusions Rates of VTE recurrence and bleeding events were both low and comparable in patients with various thrombophilias receiving either treatment, suggesting that DOACs are an appropriate treatment option in this population. Due to limited data, it is unclear whether these findings apply to specific subgroups such as high-risk antiphospholipid syndrome, uncommon thrombophilias, or the use of apixaban. SN - 1538-7836 UR - https://www.unboundmedicine.com/medline/citation/30690830/Direct_oral_anticoagulants_in_patients_with_venous_thromboembolism_and_thrombophilia:_a_systematic_review_and_meta_analysis_ L2 - https://doi.org/10.1111/jth.14398 DB - PRIME DP - Unbound Medicine ER -