PMID- 25226478
OWN - NLM
STAT- MEDLINE
DCOM- 20141020
LR  - 20220310
IS  - 1538-3598 (Electronic)
IS  - 0098-7484 (Linking)
VI  - 312
IP  - 11
DP  - 2014 Sep 17
TI  - Clinical and safety outcomes associated with treatment of acute venous 
      thromboembolism: a systematic review and meta-analysis.
PG  - 1122-35
LID - 10.1001/jama.2014.10538 [doi]
AB  - IMPORTANCE: Many anticoagulant strategies are available for the treatment of 
      acute venous thromboembolism, yet little guidance exists regarding which drug is 
      most effective and safe. OBJECTIVE: To summarize and compare the efficacy and 
      safety outcomes associated with 8 anticoagulation options (unfractionated heparin 
      [UFH], low-molecular-weight heparin [LMWH], or fondaparinux in combination with 
      vitamin K antagonists); LMWH with dabigatran or edoxaban; rivaroxaban; apixaban; 
      and LMWH alone) for treatment of venous thromboembolism. DATA SOURCES: A 
      systematic literature search was conducted using MEDLINE, EMBASE, and the 
      evidence-based medicine reviews from inception through February 28, 2014. STUDY 
      SELECTION: Eligible studies were randomized trials reporting rates of recurrent 
      venous thromboembolism and major bleeding in patients with acute venous 
      thromboembolism. Of the 1197 studies identified, 45 trials including 44,989 
      patients were included in the analyses. DATA EXTRACTION AND SYNTHESIS: Two 
      reviewers independently extracted trial-level data including number of patients, 
      duration of follow-up, and outcomes. The data were pooled using network 
      meta-analysis. MAIN OUTCOMES AND MEASURES: The primary clinical and safety 
      outcomes were recurrent venous thromboembolism and major bleeding, respectively. 
      RESULTS: Compared with the LMWH-vitamin K antagonist combination, a treatment 
      strategy using the UFH-vitamin K antagonist combination was associated with an 
      increased risk of recurrent venous thromboembolism (hazard ratio [HR], 1.42; 95% 
      credible interval [CrI], 1.15-1.79). The proportion of patients experiencing 
      recurrent venous thromboembolism during 3 months of treatment were 1.84% (95% 
      CrI, 1.33%-2.51%) for the UFH-vitamin K antagonist combination and 1.30% (95% 
      CrI, 1.02%-1.62%) for the LMWH-vitamin K antagonist combination. Rivaroxaban (HR, 
      0.55; 95% CrI, 0.35-0.89) and apixaban (HR, 0.31; 95% CrI, 0.15-0.62) were 
      associated with a lower risk of bleeding than was the LMWH-vitamin K antagonist 
      combination, with a lower proportion of patients experiencing a major bleeding 
      event during 3 months of anticoagulation: 0.49% (95% CrI, 0.29%-0.85%) for 
      rivaroxaban, 0.28% (95% CrI, 0.14%-0.50%) for apixaban, and 0.89% (95% CrI, 
      0.66%-1.16%) for the LMWH-vitamin K antagonist combination. CONCLUSIONS AND 
      RELEVANCE: Using meta-analytic pooling, there were no statistically significant 
      differences for efficacy and safety associated with most treatment strategies 
      used to treat acute venous thromboembolism compared with the LMWH-vitamin K 
      antagonist combination. However, findings suggest that the UFH-vitamin K 
      antagonist combination is associated with the least effective strategy and that 
      rivaroxaban and apixaban may be associated with the lowest risk for bleeding.
FAU - Castellucci, Lana A
AU  - Castellucci LA
AD  - Department of Medicine, the Ottawa Hospital Research Institute, University of 
      Ottawa, Ottawa, Ontario, Canada.
FAU - Cameron, Chris
AU  - Cameron C
AD  - Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, 
      Ontario, Canada.
FAU - Le Gal, Gregoire
AU  - Le Gal G
AD  - Department of Medicine, the Ottawa Hospital Research Institute, University of 
      Ottawa, Ottawa, Ontario, Canada.
FAU - Rodger, Marc A
AU  - Rodger MA
AD  - Department of Medicine, the Ottawa Hospital Research Institute, University of 
      Ottawa, Ottawa, Ontario, Canada.
FAU - Coyle, Doug
AU  - Coyle D
AD  - Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, 
      Ontario, Canada.
FAU - Wells, Philip S
AU  - Wells PS
AD  - Department of Medicine, the Ottawa Hospital Research Institute, University of 
      Ottawa, Ottawa, Ontario, Canada.
FAU - Clifford, Tammy
AU  - Clifford T
AD  - Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada.
FAU - Gandara, Esteban
AU  - Gandara E
AD  - Department of Medicine, the Ottawa Hospital Research Institute, University of 
      Ottawa, Ottawa, Ontario, Canada.
FAU - Wells, George
AU  - Wells G
AD  - Ottawa Heart Institute, Department of Epidemiology and Community Medicine, 
      University of Ottawa, Ottawa, Ontario, Canada.
FAU - Carrier, Marc
AU  - Carrier M
AD  - Department of Medicine, the Ottawa Hospital Research Institute, University of 
      Ottawa, Ottawa, Ontario, Canada.
LA  - eng
GR  - 116573/Canadian Institutes of Health Research/Canada
GR  - CGV 121171/Canadian Institutes of Health Research/Canada
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - JAMA
JT  - JAMA
JID - 7501160
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Acute Disease
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Hemorrhage/chemically induced
MH  - Humans
MH  - Risk
MH  - Venous Thromboembolism/*drug therapy
EDAT- 2014/09/17 06:00
MHDA- 2014/10/21 06:00
CRDT- 2014/09/17 06:00
PHST- 2014/09/17 06:00 [entrez]
PHST- 2014/09/17 06:00 [pubmed]
PHST- 2014/10/21 06:00 [medline]
AID - 1904827 [pii]
AID - 10.1001/jama.2014.10538 [doi]
PST - ppublish
SO  - JAMA. 2014 Sep 17;312(11):1122-35. doi: 10.1001/jama.2014.10538.