PMID- 29043538
OWN - NLM
STAT- MEDLINE
DCOM- 20180815
LR  - 20220317
IS  - 1573-742X (Electronic)
IS  - 0929-5305 (Linking)
VI  - 45
IP  - 1
DP  - 2018 Jan
TI  - Venous thromboembolism prophylaxis in medically ill patients: a mixed treatment 
      comparison meta-analysis.
PG  - 36-47
LID - 10.1007/s11239-017-1562-5 [doi]
AB  - The American College of Chest Physicians guidelines recommend unfractionated 
      heparin (UFH), low molecular weight heparins (LMWHs) or fondaparinux for 
      prevention of venous thromboembolism (VTE), including deep vein thrombosis (DVT) 
      and pulmonary embolism (PE), in medically-ill patients. Direct oral 
      anticoagulants (DOACs) have been evaluated relative to enoxaparin for VTE 
      prophylaxis though head-to-head comparisons of these agents are lacking. 
      Therefore, we conducted a mixed treatment comparisons meta-analysis to evaluate 
      the safety and efficacy of established treatments and DOACs for VTE prophylaxis 
      in medically-ill patients. A comprehensive literature search was conducted to 
      identify randomized trials evaluating UFH, LMWHs or DOACS for the prevention of 
      VTE in medically ill patients. Articles were retrieved and cross-referenced for 
      additional trials, evaluated and entered into ADDIS (version 1.16.6) to generate 
      direct and indirect treatment comparisons for VTE, DVT, PE, death from any cause, 
      and bleeding. Ten articles were included and eight anticoagulants were evaluated 
      in a treatment network representing data on 28,382 patients. We found each 
      treatment had similar efficacy in preventing VTE, DVT, PE, death from any cause 
      and each had similar risk of minor and major bleeding. Overall, placebo was 
      associated with more VTE and DVT events compared to LMWHs and DOACs. We found 
      that UFH, LMWHs and DOACs are comparable in preventing VTE, DVT, PE, and death 
      from any cause and in association with minor and major bleeding. Anticoagulant 
      selection for VTE prophylaxis in medically-ill patients should be individualized 
      by patient characteristics, risks and preferences along with specific 
      pharmacokinetic and pharmacodynamic considerations.
FAU - Al Yami, Majed S
AU  - Al Yami MS
AD  - College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, 
      Riyadh, Saudi Arabia.
FAU - Silva, Matthew A
AU  - Silva MA
AD  - School of Pharmacy - Worcester/Manchester, MCPHS University, 19 Foster Street, 
      Worcester, MA, 01608, USA.
FAU - Donovan, Jennifer L
AU  - Donovan JL
AD  - School of Pharmacy - Worcester/Manchester, MCPHS University, 19 Foster Street, 
      Worcester, MA, 01608, USA.
FAU - Kanaan, Abir O
AU  - Kanaan AO
AD  - School of Pharmacy - Worcester/Manchester, MCPHS University, 19 Foster Street, 
      Worcester, MA, 01608, USA. abir.kanaan@mcphs.edu.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PL  - Netherlands
TA  - J Thromb Thrombolysis
JT  - Journal of thrombosis and thrombolysis
JID - 9502018
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Anticoagulants/*therapeutic use
MH  - Hemorrhage/chemically induced
MH  - Humans
MH  - Premedication/adverse effects/methods
MH  - Randomized Controlled Trials as Topic
MH  - Venous Thromboembolism/complications/*prevention & control
OTO - NOTNLM
OT  - Direct oral anticoagulants
OT  - Medically ill
OT  - Mixed treatment comparison
OT  - Prevention
OT  - Venous thromboembolism
EDAT- 2017/10/19 06:00
MHDA- 2018/08/16 06:00
CRDT- 2017/10/19 06:00
PHST- 2017/10/19 06:00 [pubmed]
PHST- 2018/08/16 06:00 [medline]
PHST- 2017/10/19 06:00 [entrez]
AID - 10.1007/s11239-017-1562-5 [pii]
AID - 10.1007/s11239-017-1562-5 [doi]
PST - ppublish
SO  - J Thromb Thrombolysis. 2018 Jan;45(1):36-47. doi: 10.1007/s11239-017-1562-5.