Low-dose of oral factor Xa inhibitors in patients with a recent acute coronary syndrome: A systematic review and meta-analysis of randomized trials

Obońska, Karolina; Navarese, Eliano Pio; Lansky, Alexandra J.; Tarantini, Giuseppe; Rossini, Roberta; Koziński, Marek; Musumeci, Giuseppe; Pasquale, Giuseppe Di; Górny, Bartosz; Szcześniak, Anna; Kowalewski, Mariusz; Gurbel, Paul A.; Kubica, Jacek

doi:10.1016/j.atherosclerosis.2013.04.022

Cited by 8 publications

(2 citation statements)

References 34 publications

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“…[6][7][8] DOACs (rivaroxaban, 9 dabigatran, 10 edoxaban, 11 or apixaban 12 ), new oral anticoagulant agents, are effective in the treatment of venous thromboembolism 13 and have also been shown to reduce the risk of MACE. 14 Although the use of oral anticoagulation therapy for the PAD patients has been considered in recent guideline, 15 efficacy and safety optimal anticoagulation therapy in these patients remain a controversial topic due to the limited reports. In this context, we performed meta-analysis to focus on available evidence for antithrombotic therapy in PAD patients who required revascularization procedures or not that may aid clinicians in choosing the most appropriate treatment strategy.…”

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confidence: 99%

Efficacy and safety of DOACs in patients with peripheral arterial disease: A systematic review and meta-analysis

et al. 2021

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Background The efficacy and safety of direct oral anticoagulants (DOACs) in patients with peripheral arterial disease are not completely understood. Therefore, we conducted a meta-analysis to explore the effects of DOACs in this population. Methods We systematically searched the PubMed, Cochrane Library, and Web of Science till April 2020 for relevant randomized controlled trials and observational studies, with no linguistic restrictions. The efficacy outcomes were cardiovascular death, stroke, myocardial infraction, major adverse cardiovascular events (MACE), acute limb ischemia, amputation, and target lesion revascularization. The safety outcome was major bleeding events. Random effects risk ratios with 95% confidence intervals were calculated. Results A total four randomized controlled trials were included in this meta-analysis. Among peripheral arterial disease patients, DOACs did not reduce the risk of cardiovascular death (RR = 1.02 95%CI 0.75–1.37, P = 0.92), stroke (RR = 0.73 95%CI 0.46–1.14, P = 0.16), myocardial infraction (RR = 0.85 95%CI 0.70–1.03, P = 0.10), MACE (RR = 0.73 95%CI 0.46–1.14, P = 0.16), or amputation (RR = 0.73 95%CI 0.46–1.14, P = 0.16) compared with control. However, DOACs were associated with reduction in acute limb ischemia (RR = 0.67 95%CI 0.55–0.80, P < 0.01) and target lesion revascularization (RR = 0.89 95%CI 0.81–0.99, P = 0.02) at the expense of major bleeding events (RR = 1.43 95%CI 1.16–1.77, P < 0.01) compared with control. Conclusions Based on current evidence, no significant difference in cardiovascular death, stroke, myocardial infraction, MACE, and amputation was found when DOACs were compared to antiplatelet monotherapy. The benefits of preventing target lesion revascularization and acute limb ischemia were balanced by amplified risk of major bleeding. Larger randomized controlled trials are needed to figure out the uncertainty around efficacy and safety of medications for peripheral arterial disease.

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Section: Introductionmentioning

confidence: 99%

Efficacy and safety of DOACs in patients with peripheral arterial disease: A systematic review and meta-analysis

et al. 2021

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“…7 Previous reviews and meta-analyses have investigated the benefit of DPI therapy over aspirin alone but have not excluded patients taking thienopyridines. [8][9][10][11][12] Thienopyridines are irreversible ADP receptor/P2Y 12 inhibitors that have an antiplatelet effect, and therefore reduce CV risk and increase bleeding risk. We performed a systematic literature review to identify studies comparing the effect of DPI therapy with aspirin alone in patients with CAD and PAD.…”

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Dual-pathway Inhibition with Low-dose Aspirin and Rivaroxaban versus Aspirin Monotherapy in Patients with Coronary Artery Disease and Peripheral Artery Disease: Systematic Literature Review and Meta-analysis

Sibbing,

Blaha,

Chawla

et al. 2024

Eur Cardiol

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Background: Low-dose aspirin lowers cardiovascular event risk; dual-pathway inhibition (DPI) using low-dose aspirin with low-dose rivaroxaban may reduce this risk further. A systematic literature review and meta-analysis compared the efficacy, safety and net clinical benefit (NCB) of DPI with aspirin. Methods: PubMed and Embase were searched for randomised controlled trials reporting clinical efficacy, safety and NCB of DPI compared with aspirin alone in patients with coronary artery disease (CAD) and/or peripheral artery disease. Six articles representing four trials were included. Results: DPI versus aspirin alone significantly reduced major adverse cardiovascular events (HR 0.77; 95% CI [0.69–0.87]; p<0.01), increased International Society on Thrombosis and Haemostasis major bleeding events (HR 1.67; 95% CI [1.37–2.02]; p<0.01) and resulted in a significant NCB (HR 0.79; 95% CI [0.70–0.90]; p<0.01). Conclusion: These results underscore the potential benefit of DPI in patients with CAD, including those in the immediate post-acute coronary syndrome stage and with established CAD, as well as patients with peripheral artery disease.

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Cost-effectiveness of andexanet alfa versus four-factor prothrombin complex concentrate for the treatment of oral factor Xa inhibitor-related intracranial hemorrhage in the US

Fanikos

Goldstein

Lovelace

et al. 2022

Journal of Medical Economics

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Low-dose of oral factor Xa inhibitors in patients with a recent acute coronary syndrome: A systematic review and meta-analysis of randomized trials

Cited by 8 publications

References 34 publications

Efficacy and safety of DOACs in patients with peripheral arterial disease: A systematic review and meta-analysis

Efficacy and safety of DOACs in patients with peripheral arterial disease: A systematic review and meta-analysis

Dual-pathway Inhibition with Low-dose Aspirin and Rivaroxaban versus Aspirin Monotherapy in Patients with Coronary Artery Disease and Peripheral Artery Disease: Systematic Literature Review and Meta-analysis

Cost-effectiveness of andexanet alfa versus four-factor prothrombin complex concentrate for the treatment of oral factor Xa inhibitor-related intracranial hemorrhage in the US

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