Impact of Age, Sex, and Renal Function on the Efficacy and Safety of Direct Oral Anticoagulants vs. Vitamin K Antagonists for the Treatment of Acute Venous Thromboembolism: A Meta-Analysis of 22,040 Patients
Objective: In this study, we conducted a meta-analysis to assess the impact of age, sex, and renal function on the efficacy and safety of direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKAs) for the treatment of acute venous thromboembolism (VTE).Methods: Electronic databases (accesse...
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2021-09-01
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doaj-240d984c92a04b47a4d302622630a0882021-09-08T04:52:34ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2021-09-01810.3389/fcvm.2021.700740700740Impact of Age, Sex, and Renal Function on the Efficacy and Safety of Direct Oral Anticoagulants vs. Vitamin K Antagonists for the Treatment of Acute Venous Thromboembolism: A Meta-Analysis of 22,040 PatientsBo Zhou0Haoyu Wu1Haoyu Wu2Chen Wang3Chen Wang4Bowen Lou5Bowen Lou6Jianqing She7Jianqing She8Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ChinaCardiovascular Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ChinaKey Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, ChinaCardiovascular Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ChinaKey Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, ChinaCardiovascular Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ChinaKey Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, ChinaCardiovascular Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ChinaKey Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, ChinaObjective: In this study, we conducted a meta-analysis to assess the impact of age, sex, and renal function on the efficacy and safety of direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKAs) for the treatment of acute venous thromboembolism (VTE).Methods: Electronic databases (accessed till June 2021) were systematically searched to investigate randomized clinical trials evaluating apixaban, dabigatran, edoxaban, and rivaroxaban vs. VKAs for the treatment of acute VTE. Results were presented as odds ratio (OR) and 95% CIs.Results: Direct oral anticoagulants were associated with a borderline higher efficacy in women (OR: 0.79, 95% CI: 0.62–1.02), a significantly higher efficacy in patients with age more than 75 years (OR: 0.51, 95% CI: 0.32–0.80), and creatinine clearance <50 ml/min (OR: 0.57, 95% CI: 0.32–0.99). The primary safety endpoint of major or clinically relevant non-major bleeding was significantly reduced in DOACs as compared to VKAs in both patients with age <75 years (OR: 0.79, 95% CI: 0.70–0.89) and patients with age more than 75 years (OR: 0.75, 95% CI: 0.59–0.96). DOACs also show an advantage in terms of major or clinically relevant non-major bleeding in men (OR: 0.72, 95% CI: 0.60–0.86) and patients with creatinine clearance of more than 50 ml/min (OR: 0.75, 95% CI: 0.67–0.84).Conclusions: Direct oral anticoagulants have exhibited clinical preference among patients with acute VTE with decreased thrombosis and bleeding events, especially in patients with age more than 75 years and creatinine clearance <50 ml/min.https://www.frontiersin.org/articles/10.3389/fcvm.2021.700740/fullvenous thromboembolismdirect oral anticoagulantsvitamin K antagonistsmeta-analysisefficacysafety |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Bo Zhou Haoyu Wu Haoyu Wu Chen Wang Chen Wang Bowen Lou Bowen Lou Jianqing She Jianqing She |
spellingShingle |
Bo Zhou Haoyu Wu Haoyu Wu Chen Wang Chen Wang Bowen Lou Bowen Lou Jianqing She Jianqing She Impact of Age, Sex, and Renal Function on the Efficacy and Safety of Direct Oral Anticoagulants vs. Vitamin K Antagonists for the Treatment of Acute Venous Thromboembolism: A Meta-Analysis of 22,040 Patients Frontiers in Cardiovascular Medicine venous thromboembolism direct oral anticoagulants vitamin K antagonists meta-analysis efficacy safety |
author_facet |
Bo Zhou Haoyu Wu Haoyu Wu Chen Wang Chen Wang Bowen Lou Bowen Lou Jianqing She Jianqing She |
author_sort |
Bo Zhou |
title |
Impact of Age, Sex, and Renal Function on the Efficacy and Safety of Direct Oral Anticoagulants vs. Vitamin K Antagonists for the Treatment of Acute Venous Thromboembolism: A Meta-Analysis of 22,040 Patients |
title_short |
Impact of Age, Sex, and Renal Function on the Efficacy and Safety of Direct Oral Anticoagulants vs. Vitamin K Antagonists for the Treatment of Acute Venous Thromboembolism: A Meta-Analysis of 22,040 Patients |
title_full |
Impact of Age, Sex, and Renal Function on the Efficacy and Safety of Direct Oral Anticoagulants vs. Vitamin K Antagonists for the Treatment of Acute Venous Thromboembolism: A Meta-Analysis of 22,040 Patients |
title_fullStr |
Impact of Age, Sex, and Renal Function on the Efficacy and Safety of Direct Oral Anticoagulants vs. Vitamin K Antagonists for the Treatment of Acute Venous Thromboembolism: A Meta-Analysis of 22,040 Patients |
title_full_unstemmed |
Impact of Age, Sex, and Renal Function on the Efficacy and Safety of Direct Oral Anticoagulants vs. Vitamin K Antagonists for the Treatment of Acute Venous Thromboembolism: A Meta-Analysis of 22,040 Patients |
title_sort |
impact of age, sex, and renal function on the efficacy and safety of direct oral anticoagulants vs. vitamin k antagonists for the treatment of acute venous thromboembolism: a meta-analysis of 22,040 patients |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Cardiovascular Medicine |
issn |
2297-055X |
publishDate |
2021-09-01 |
description |
Objective: In this study, we conducted a meta-analysis to assess the impact of age, sex, and renal function on the efficacy and safety of direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKAs) for the treatment of acute venous thromboembolism (VTE).Methods: Electronic databases (accessed till June 2021) were systematically searched to investigate randomized clinical trials evaluating apixaban, dabigatran, edoxaban, and rivaroxaban vs. VKAs for the treatment of acute VTE. Results were presented as odds ratio (OR) and 95% CIs.Results: Direct oral anticoagulants were associated with a borderline higher efficacy in women (OR: 0.79, 95% CI: 0.62–1.02), a significantly higher efficacy in patients with age more than 75 years (OR: 0.51, 95% CI: 0.32–0.80), and creatinine clearance <50 ml/min (OR: 0.57, 95% CI: 0.32–0.99). The primary safety endpoint of major or clinically relevant non-major bleeding was significantly reduced in DOACs as compared to VKAs in both patients with age <75 years (OR: 0.79, 95% CI: 0.70–0.89) and patients with age more than 75 years (OR: 0.75, 95% CI: 0.59–0.96). DOACs also show an advantage in terms of major or clinically relevant non-major bleeding in men (OR: 0.72, 95% CI: 0.60–0.86) and patients with creatinine clearance of more than 50 ml/min (OR: 0.75, 95% CI: 0.67–0.84).Conclusions: Direct oral anticoagulants have exhibited clinical preference among patients with acute VTE with decreased thrombosis and bleeding events, especially in patients with age more than 75 years and creatinine clearance <50 ml/min. |
topic |
venous thromboembolism direct oral anticoagulants vitamin K antagonists meta-analysis efficacy safety |
url |
https://www.frontiersin.org/articles/10.3389/fcvm.2021.700740/full |
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