Historically, Warfarin ( Coumadin ) or Acetylsalicylic acid ( Aspirin ) have been the recommended therapeutic options for the extended treatment ( more than 3 months ) of venous thromboembolism ( VTE ).
Data from phase III randomised controlled trials ( RCTs ) are now available for non-VKA oral anticoagulants ( NOACs ) in this indication.
The current systematic review and network meta-analysis were conducted to compare the efficacy and safety of anticoagulants for the extended treatment of venous thromboembolism.
Eleven phase III RCTs ( examining Apixaban [ Eliquis ], Aspirin, Dabigatran [ Pradaxa ], Rivaroxaban [ Xarelto ], Warfarin and placebo ) were included.
The risk of the composite efficacy outcome ( VTE and VTE-related death ) was statistically significantly lower with the NOACs and Warfarin INR 2.0-3.0 compared with Aspirin, with no significant differences between the NOACs.
Treatment with Apixaban ( RR=0.23, 95% CrI 0.10, 0.55 ) or Dabigatran ( RR=0.55, 95% Crl 0.43, 0.71 ) was associated with a statistically significantly reduced risk of major or clinically relevant non-major bleed compared with Warfarin INR 2.0-3.0.
Apixaban also showed a significantly reduced risk compared with Dabigatran ( RR=0.42, 95% Crl 0.18, 0.97 ) and Rivaroxaban ( RR=0.23, 95% Crl 0.09, 0.59 ).
Sensitivity analyses indicate that results were dependent on the dataset, but not on the type of network meta-analysis model employed.
In conclusion, results from the network meta-analysis have indicated that NOACs are an effective treatment for prevention of VTE or VTE-related death in the extended treatment setting.
However, bleeding risk differs between potential treatments, with Apixaban reporting the most favourable profile compared with other NOACs, Warfarin INR 2.0-3.0, and Aspirin. ( Xagena )
Cohen AT et al, PLoS One 2016;11(8):e0160064. doi: 10.1371/journal.pone.0160064. eCollection 2016