Effectiveness and Safety of Nonvitamin K Oral Anticoagulants Rivaroxaban and Apixaban in Patients with Venous Thromboembolism: A Meta-Analysis of Real-World Studies

Wu, O. , Morris, S., Larsen, T. B., Skjøth, F., Evans, A., Bowrin, K., Wojciechowski, P., Margas, W. and Huelsebeck, M. (2022) Effectiveness and Safety of Nonvitamin K Oral Anticoagulants Rivaroxaban and Apixaban in Patients with Venous Thromboembolism: A Meta-Analysis of Real-World Studies. Cardiovascular Therapeutics, 2022, 2756682. (doi: 10.1155/2022/2756682) (PMID:35801133) (PMCID:PMC9203223)

Abstract

Background. Rivaroxaban and apixaban are the most widely used nonvitamin K oral anticoagulants (NOACs) in patients with venous thromboembolism (VTE). This meta-analysis evaluates the effectiveness and safety of both NOACs versus standard of care (SoC) in real-world practice. Methods. Real-world evidence (RWE) studies were identified through a systematic literature review conducted between January 2012 and July 2020, using Embase, MEDLINE, and the websites of cardiological, hematological, and oncological associations. Eligible RWE studies recruited adult patients with deep vein thrombosis and/or pulmonary embolism and presented a comparison between rivaroxaban and apixaban versus SoC, consisting either of vitamin K antagonists, heparins, or combinations thereof. Hazard ratios (HRs) for the comparison between NOACs and SoC were extracted from the relevant studies or estimated based on the reported binary data. The between-treatment contrasts were reported as HRs with associated 95% confidence intervals. Results. A total of 65 RWE studies were identified and considered relevant for the meta-analysis. Compared with SoC, both rivaroxaban and apixaban were associated with reduced risks of recurrent VTE and a lower rate of major bleeding events. Patients treated with rivaroxaban were at a lower risk of all-cause death compared with those receiving SoC ( [0.39-0.80]), while evidence for apixaban from the identified studies was insufficient to demonstrate a statistically significant change in mortality ( [0.30-1.47]). Conclusion. This analysis indicates that in real-world practice, rivaroxaban and apixaban are associated with a lower risk of recurrent VTE and major bleeding events compared with SoC. Survival benefit in patients treated with rivaroxaban was also observed.

• Item Type: Articles
• Keywords: Pharmacology (medical), Cardiology and Cardiovascular Medicine, Pharmacology, General Medicine
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Wu, Professor Olivia
• Authors: Wu, O., Morris, S., Larsen, T. B., Skjøth, F., Evans, A., Bowrin, K., Wojciechowski, P., Margas, W., and Huelsebeck, M.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
• Journal Name: Cardiovascular Therapeutics
• Publisher: Hindawi
• ISSN: 1755-5914
• ISSN (Online): 1755-5922
• Published Online: 09 June 2022
• Copyright Holders: Copyright © 2022 Olivia Wu et al
• First Published: First published in Cardiovascular Therapeutics 2022: 2756682
• Publisher Policy: Reproduced under a Creative Commons licence