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SYSTEMATIC REVIEW article

Front. Pharmacol.
Sec. Drugs Outcomes Research and Policies
Volume 15 - 2024 | doi: 10.3389/fphar.2024.1519869
This article is part of the Research Topic State of the Art in Antithrombotic Therapy View all 3 articles

Efficacy and safety of anticoagulants on venous thromboembolism: A systematic review and network meta-analysis of randomized controlled trials

Provisionally accepted
Weijie Fu Weijie Fu Maolin Zhao Maolin Zhao Sheng Ding Sheng Ding Mei Xin Mei Xin Ke Yang Ke Yang Li Jiang Li Jiang Fan Wu Fan Wu Xiaochen Wu Xiaochen Wu Jian Wang Jian Wang Jie Chen Jie Chen Feng Gao Feng Gao Siyi He Siyi He *
  • General Hospital of Western Theater Command, Chengdu, China

The final, formatted version of the article will be published soon.

    Background Anticoagulants are the primary means for the treatment and prevention of venous thromboembolism (VTE), but their clinical standardized application still remains controversial. The present study intends to comprehensively compare the efficacy and safety of various anticoagulants in VTE. Methods Medline, Embase, and Cochrane Library from their inception up to August 2023 were searched to compare the efficacy and safety of various anticoagulants in VTE. We extracted data on study settings, baseline characteristics, interventions, and outcomes, applying the intention-to-treat principle. Two researchers assessed study bias using the Cochrane tool, resolving disagreements through discussion or third-party adjudication. Network meta-analyses were performed based on Bayesian generalized linear models, and a frequentist framework with multivariate random effects was used to fit the model. Results In terms of treatment, 58 trials with 119,417 patients proved eligible, while 125 trials with 225,414 patients were included in terms of prevention. All anticoagulants were found to reduce the recurrence or incidence of VTE compared with Placebo, of which high-level evidence indicated that direct thrombin inhibitors (TIs) and novel oral anticoagulants (NOACs) were the two most effective drugs. For treatment, low molecular weight heparin (LMWH), unfractionated heparin (UFH), and vitamin K antagonists (VKAs) significantly increased the risk of major bleeding in comparison to Placebo. For prevention, only UFH (OR 2.0, 95% CI 1.2-3.3) and NOACs (OR 1.8, 95% CI 1.2-2.6) showed significant increased risks in major bleeding. Additionally, after an exhaustive analysis of NOACs, analysis showed that apixaban （RR 0.5, 95%CI 0.17-1.46）had a superior performance in major bleeding compared to rivaroxaban（RR 3.87, 95%CI 1.48-10.09）. Conclusion TIs and NOACs were superior in efficacy with minimal side effects, making them pivotal choices for both prevention and treatment of VTE. Clinical practitioners must carefully weigh drug characteristics, indications, and contraindications to optimize treatment outcomes.

    Keywords: Anticoagulants, Meta-analysis, Systematic review, Venous Thromboembolism, novel oral anticoagulants

    Received: 30 Oct 2024; Accepted: 24 Dec 2024.

    Copyright: © 2024 Fu, Zhao, Ding, Xin, Yang, Jiang, Wu, Wu, Wang, Chen, Gao and He. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Siyi He, General Hospital of Western Theater Command, Chengdu, China

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