Current evidence on the effectiveness and safety of oral anticoagulants in superficial venous thrombosis: a systematic review and meta-analysis.

IF 1.5 4区医学 Q3 PERIPHERAL VASCULAR DISEASE International Angiology Pub Date : 2024-11-04 DOI:10.23736/S0392-9590.24.05309-4

Vito A Damay, Ignatius Ivan, Marc Vuylsteke

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Abstract

Introduction: Previous studies suggest fondaparinux as an effective regimen for superficial venous thrombosis (SVT), but the inconvenience of prolonged parenteral injections has prompted investigations into oral anticoagulants (OACs). This study aims to evaluate the current evidence on the effectiveness and safety of OACs in the treatment of SVT.

Evidence acquisition: Following the PRISMA 2020 guidelines, we conducted a systematic review and meta-analysis registered in PROSPERO (CRD42024535625). A comprehensive literature search was performed across multiple databases up to April 2024. Studies were included if they involved adult patients diagnosed with SVT, treated with OACs, and reported relevant efficacy and safety outcomes. Both randomized controlled trials (RCTs) and observational studies were considered. Data extraction and risk of bias assessments were independently performed by two authors.

Evidence synthesis: The search identified 1531 studies, with six studies (three RCTs and three prospective cohort studies) meeting inclusion criteria. Meta-analysis for Rivaroxaban-treated group showed DVT occurrence was 1.30% (95% CI 0.17-3.07%), SVT extension was 0.32% (95% CI: 0.00-1.58%), SVT recurrence was 0.75% (95% CI: 0.00-3.30%), clinically relevant non-major bleeding was 1.95% (95% CI: 0.46-4.11%), minor bleeding was 5.68% (95% CI: 3.02-9.01%). These estimates were for patients treated with rivaroxaban 10-20 mg once daily over 42 days to 37 months. No major bleeding was reported with rivaroxaban 10 mg once daily.

Conclusions: This systematic review and meta-analysis demonstrate that OACs, especially rivaroxaban, are effective and safe for the treatment of SVT. They offer a convenient alternative to parenteral anticoagulants, potentially improving patient compliance and outcomes. However, further large-scale studies are warranted to confirm these findings.

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关于口服抗凝剂对浅静脉血栓形成的有效性和安全性的现有证据：系统回顾和荟萃分析。

导言：以往的研究表明，磺达肝癸是治疗浅静脉血栓形成（SVT）的有效方案，但长期肠外注射带来的不便促使人们开始研究口服抗凝剂（OAC）。本研究旨在评估目前有关 OACs 治疗 SVT 的有效性和安全性的证据：按照 PRISMA 2020 指南，我们在 PROSPERO（CRD42024535625）上注册了一项系统性综述和荟萃分析。截至 2024 年 4 月，我们在多个数据库中进行了全面的文献检索。凡涉及确诊为室上性心动过速、接受 OACs 治疗并报告了相关疗效和安全性结果的成年患者的研究均被纳入。随机对照试验（RCT）和观察性研究均在考虑之列。数据提取和偏倚风险评估由两位作者独立完成：检索发现了 1531 项研究，其中 6 项研究（3 项随机对照试验和 3 项前瞻性队列研究）符合纳入标准。利伐沙班治疗组的 Meta 分析显示，深静脉血栓发生率为 1.30% (95% CI 0.17-3.07%)，SVT 延长率为 0.32% (95% CI: 0.00-1.58%)，SVT 复发率为 0.75% (95% CI: 0.00-3.30%)，临床相关非大出血率为 1.95% (95% CI: 0.46-4.11%)，轻微出血率为 5.68% (95% CI: 3.02-9.01%)。这些估计值适用于接受利伐沙班治疗的患者，每天一次，每次 10-20 毫克，治疗时间为 42 天至 37 个月。利伐沙班 10 毫克，每日一次，未报告有大出血：本系统综述和荟萃分析表明，OACs（尤其是利伐沙班）治疗室上性心动过速既有效又安全。它们提供了一种替代肠外抗凝药的便捷方法，有可能改善患者的依从性和治疗效果。然而，还需要进一步的大规模研究来证实这些发现。

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来源期刊

International Angiology 医学-外周血管病

CiteScore

2.80

自引率

28.60%

发文量

审稿时长

6-12 weeks

期刊介绍： International Angiology publishes scientific papers on angiology. Manuscripts may be submitted in the form of editorials, original articles, review articles, special articles, letters to the Editor and guidelines. The journal aims to provide its readers with papers of the highest quality and impact through a process of careful peer review and editorial work. Duties and responsibilities of all the subjects involved in the editorial process are summarized at Publication ethics. Manuscripts are expected to comply with the instructions to authors which conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Editors by the International Committee of Medical Journal Editors (ICMJE).