EFFICACY AND SAFETY OF THE ORAL ANTICOAGULANTS IN THE MANAGEMENT OF VENOUS THROMBOEMBOLISM: INDIRECT COMPARISON

Abstract

Objective. The aim was to perform an indirect comparisons of the effectiveness and safety of new oral anticoagulants (NOACs) in the management of venous thromboembolism (VTE).Material and methods. In the absence of a head-to-head comparisons, indirect comparison was done using the method proposed by Butcher et al.Results. The indirect comparison included 5 RCTs. Apixaban, rivaroxaban and dabigatran were equally effective in preventing recurrent symptomatic VTE, deep vein thrombosis and pulmonary embolism. Dabigatran increased major bleeding risk compared to apixaban RR=2.36; 95% CI 1.15-4.82 and the risk major or clinical relevant non-major (CRNM) bleedings RR=1.43; 95% CI 1.06-1.93. Dabigatran and apixaban were associated with the significant lower risk of major and CRNM bleeding compared with rivaroxaban RR=1.49; 95% CI 1.17-1.91 and RR=2.13; 95% CI 1.66-2.74.Conclusions. There were no statistically significant differences between apixaban, dabigatran and rivaroxaban in effectiveness. Apixaban treatment associated with the most favorable safety profile of the NOACs.

Keywords

• indirect comparison
• new oral anticoagulants
• venous thromboembolism
• rivaroxaban
• apixaban
• dabigatran