Meta-analysis on efficacy and safety of new oral anticoagulants for venous thromboembolism prophylaxis in elderly elective postarthroplasty patients

Pathak, Ranjan; Giri, Smith; Karmacharya, Paras; Aryal, Madan Raj; Poudel, Dilli Ram; Ghimire, Sushil; Jehangir, Asad; Shaikh, Bilal Fazal; Rettew, Andrew; Donato, Anthony A.

doi:10.1097/mbc.0000000000000369

Cited by 9 publications

(10 citation statements)

References 28 publications

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“…The same group reported similar results in a network meta-analysis of 25 RCT 1907 . Conversely, a meta-analysis of 9 RCT in elderly TKA and THA patients found that VTE or VTE-related death (OR 0.10; 95% CI 0.01 - 0.81) was reduce with apixaban compared to enoxaparin, although the rates were similar for rivaroxaban compared to enoxaparin (OR 0.75; 95% CI 0.35 - 1.59) 1908 .…”

Section: - Are There Differences Between Various Factor Xa Inhibitors...mentioning

confidence: 96%

“…Nieto et al 1905 , found that there was the highest risk of major bleeding with rivaroxaban compared to enoxaparin (RR 1.88; 95% CI 0.92 - 3.82), while apixaban (RR 0.76; 95% CI 0.43 - 1.33) trended toward less events compared to enoxaparin. Pathak et al 1908 , found that apixaban (OR 0.71; 95% CI 0.47 - 1.08) and rivaroxaban (OR 0.78; 95% CI 0.48 - 1.27) had similar risk of major or clinically relevant bleeding compared to enoxaparin. Lewis et al 1906 , reported similar risk of major bleeding for apixaban (RR 3.16; 95% CI 0.47 - 21.15) and rivaroxaban (RR 2.74; 95% CI 0.42 - 16.16).…”

Section: - Are There Differences Between Various Factor Xa Inhibitors...mentioning

confidence: 99%

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Recommendations from the ICM-VTE: General

2022

Journal of Bone and Joint Surgery

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Section: - Are There Differences Between Various Factor Xa Inhibitors...mentioning

confidence: 96%

Section: - Are There Differences Between Various Factor Xa Inhibitors...mentioning

confidence: 99%

Recommendations from the ICM-VTE: General

2022

Journal of Bone and Joint Surgery

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“…Given their susceptibility to various diseases, multiple prescriptions, and attenuation of renal and liver function, the efficacy and safety of anticoagulants are both important to the elderly. A meta-analysis including 29,403 elective postarthroplasty elderly indicated that, with NOACs, the risk of VTE or VTE-related death was similar to that with LMWHs (odds ratio [OR] 0.62, 95% CI 0.30-1.26; p 0.18; I 2 44%), but the bleeding risk was significantly lower (OR 0.71, 95% CI 0.53-0.94; p 0.02; I 2 0%) (Pathak et al, 2015). However, our direct comparisons showed that LMHWs are less effective than NOACs although the safety profile showed no significant difference.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Low Molecular Weight Heparin for Thromboprophylaxis in the Elderly: A Network Meta-Analysis of Randomized Clinical Trials

Yang

Liu

et al. 2021

Front. Pharmacol.

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Background: Given their changing pathophysiology, elderly patients carry a high risk of embolism and bleeding events; hence, use of appropriate anticoagulants is very important. Low molecular weight heparin (LMWH) is one of the most widely used anticoagulants although LMWHs differ in their anti-Xa, antithrombin, and anticoagulant activities. To date, no study has directly compared the safety and efficacy of different LMWHs in the elderly. We aimed to compare such differences by conducting a network meta-analysis.Methods: We searched the Pubmed, Embase, and Cochrane databases for randomized controlled trials (RCTs) of LMWHs that included patients ≥60 years old up to July 22, 2020. Safety outcomes included venous thromboembolism (VTE) or VTE-related death, deep thrombus embolism, and pulmonary embolism. Safety outcomes were clinically relevant bleeding, major bleeding, minor bleeding, and all-cause death. We calculated relative ratios (RR) and 95% confidence intervals (CI) for all outcomes. The cumulative ranking probabilities (SUCRA) were conducted to rank the comparative effects and safety of all LMWHs.Results: We included 27 RCTs (30,441 elderly), comprising five LMWHs. LMWH was more effective than placebo in preventing VTE or VTE-related death (RR 0.36, 95% CI 0.25–0.53) but less effective than a novel oral anticoagulant (RR 1.59, 95% CI 1.33–1.91) and safer than acenocoumarol regarding risk of clinically relevant bleeding (RR 0.67, 95% CI 0.49–0.90). However, indirect comparison of efficacy and safety of the five LMWHs showed no significant difference in our network analysis, and the subgroup analyses (such as in patients with deep venous thrombosis, cardiac disease, or age >65 years old) supported the results. The SUCRA showed that tinzaparin performed best in preventing VTE or VTE-related death (SUCRA 68.8%, cumulative probability 42.3%) and all-cause death (SUCRA 84.2%, cumulative probability 40.7%), whereas nadroparin was predominant in decreasing the risk of clinically relevant bleeding (SUCRA 84.8%, cumulative probability 77.0%).Conclusions: On present evidence, there are no significant differences in the efficacy and safety of different LMWHs for the elderly. According to the rank probability analysis, nadroparin seems to be safer for the elderly with a high risk of bleeding, whereas tinzaparin is more effective for those with low bleeding risk.

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“…29 For thromboprophylaxis after orthopedic surgery, a metaanalysis found similar efficacy and safety of DOACs in elderly obese and non-obese patients. 30 A meta-analysis of the major DOAC trials for treatment of VTE found no difference in efficacy or major bleeding between subgroups of patients with body weight ,100 kg vs .100 kg. 31 It should be noted, however, that these trials had very few patients with body weight .120 kg.…”

Section: Doacsmentioning

confidence: 99%

Thrombosis in the setting of obesity or inflammatory bowel disease

Lentz

2016

Hematology

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Obesity and inflammatory bowel disease (IBD) are systemic inflammatory disorders that predispose to arterial and venous thrombosis through similar prothrombotic mechanisms. Obesity and IBD are chronic risk factors that lead to a persistently elevated risk of thrombosis, although the thrombotic risk with IBD appears to wax and wane with disease severity. Because of the lack of high-quality evidence to guide management decisions, approaches to the prevention and treatment of thrombosis in patients with obesity or IBD are based on extrapolation from general guidelines for antithrombotic therapy. Obesity alters the pharmacokinetics of some anticoagulant drugs, and IBD patients present the added management challenge of having a high risk of gastrointestinal bleeding while taking anticoagulants. An extended duration of anticoagulant therapy is often recommended for obese or IBD patients with unprovoked venous thromboembolism unless there is a high risk of bleeding, although more data and better biomarkers are needed to determine whether anticoagulation can be safely stopped in a subset of IBD patients during remission of active disease. Most patients with obesity or IBD require thromboprophylaxis in conjunction with hospitalization or surgery, with adjustment of anticoagulant dosing in patients with severe obesity.

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Meta-analysis on efficacy and safety of new oral anticoagulants for venous thromboembolism prophylaxis in elderly elective postarthroplasty patients

Cited by 9 publications

References 28 publications

Recommendations from the ICM-VTE: General

Recommendations from the ICM-VTE: General

Safety and Efficacy of Low Molecular Weight Heparin for Thromboprophylaxis in the Elderly: A Network Meta-Analysis of Randomized Clinical Trials

Thrombosis in the setting of obesity or inflammatory bowel disease

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