Direct Oral Anticoagulants in Patients with Venous Thromboembolism and Thrombophilia: A Systematic Review and Meta-Analysis.
J Thromb Haemost. 2019 Jan 28;:
Authors: Elsebaie MA, van Es N, Langston A, Büller HR, Gaddh M
Abstract
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 1,994 thrombophilia patients were included in a random-effects meta-analysis. Eligible studies were phase 2-3 randomized controlled trials comparing DOACs to vitamin K antagonists (VKAs) in patients with VTE, including those with thrombophilia.
RESULTS: Of 8 studies included in meta-analysis, 4 evaluated rivaroxaban, 3 dabigatran, and 1 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 anti-phospholipid syndrome, uncommon thrombophilias, or to the use of apixaban. This article is protected by copyright. All rights reserved.
PMID: 30690830 [PubMed - as supplied by publisher]