Comparative Safety and Efficacy of Non-vitamin K Antagonist Oral Anticoagulants (NOACs) Versus Warfarin in Deep Vein Thrombosis (DVT) Treatment: A Meta-analysis.

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular Drugs and Therapy Pub Date : 2024-12-27 DOI:10.1007/s10557-024-07654-1

Manwei Hao, Zhongchao Wang, Han Gao, Haicheng Gao, Zhihua Cheng

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Abstract

Purpose: This meta-analysis aimed to conduct a systematic evaluation of the comparative efficacy and safety of new oral anticoagulants (NOACs) versus warfarin for the treatment of deep venous thrombosis (DVT).

Methods: A systematic computerized search of databases including PubMed, Medline, Web of Science, Embase, Cochrane Library, and www.

Clinicaltrials: gov . was performed to gather research on the efficacy and safety of NOACs versus warfarin in the treatment of DVT, encompassing all records from the inception of each database through September 2024. The discrete data were presented as odds ratios (ORs) with their corresponding 95% confidence intervals (CIs), and the meta-analysis was executed utilizing the Review Manager 5.4.1 and Stata 16 softwares.

Results: A comprehensive analysis of 16 studies encompassing 10,084 patients was conducted, with 6704 individuals in the experimental group receiving NOACs and 3380 in the control group treated with warfarin. The findings are as follows: (1) NOACs demonstrated enhanced treatment efficacy over warfarin, particularly in achieving vascular patency (OR = 1.57, 95% CI (1.09, 2.24), P = 0.01). (2) Regarding the incidence of major bleeding events (OR = 0.65, 95% CI (0.54, 0.78), P < 0.00001), other clinical adverse events-including pulmonary embolism, mortality, stroke, myocardial infarction and recurrent thrombosis (OR = 0.77, 95% CI (0.67, 0.88), P = 0.0002), and post-thrombotic syndrome (PTS) (OR = 0.62, 95% CI (0.47, 0.80), P = 0.0003); NOACs offered improved safety profiles in comparison to warfarin. Furthermore, subgroup analysis revealed that the preventive efficacy of NOACs against PTS improves with longer follow-up periods (P = 0.02).

Conclusion: NOACs have demonstrated superior efficacy and safety profiles in the treatment of DVT compared to traditional warfarin anticoagulant therapy.

Clinical trial registration: This project did not involve any clinical data collection; the data utilized were derived from articles published in PubMed.

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非维生素K拮抗剂口服抗凝剂（NOACs）与华法林治疗深静脉血栓（DVT）的安全性和有效性比较：一项荟萃分析。

目的：本荟萃分析旨在对新型口服抗凝剂（NOACs）与华法林治疗深静脉血栓（DVT）的疗效和安全性进行系统评价。方法：系统计算机检索PubMed、Medline、Web of Science、Embase、Cochrane Library和www.Clinicaltrials: gov等数据库。收集了NOACs与华法林治疗DVT的有效性和安全性的研究，包括每个数据库从建立到2024年9月的所有记录。离散数据以比值比（or）及其相应的95%置信区间（ci）表示，使用Review Manager 5.4.1和Stata 16软件进行meta分析。结果：对16项研究10084例患者进行了综合分析，实验组6704例接受NOACs治疗，对照组3380例接受华法林治疗。结果表明：(1)NOACs治疗效果优于华法林，尤其在血管通畅方面（OR = 1.57, 95% CI (1.09, 2.24), P = 0.01）。(2)在大出血事件发生率方面（OR = 0.65, 95% CI (0.54, 0.78)， P）结论：与传统华法林抗凝治疗相比，NOACs治疗DVT具有更优越的疗效和安全性。临床试验注册：本项目不涉及任何临床数据收集；所使用的数据来源于PubMed上发表的文章。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiovascular Drugs and Therapy 医学-心血管系统

CiteScore

8.30

自引率

0.00%

发文量

110

审稿时长

4.5 months

期刊介绍： Designed to objectively cover the process of bench to bedside development of cardiovascular drug, device and cell therapy, and to bring you the information you need most in a timely and useful format, Cardiovascular Drugs and Therapy takes a fresh and energetic look at advances in this dynamic field. Homing in on the most exciting work being done on new therapeutic agents, Cardiovascular Drugs and Therapy focusses on developments in atherosclerosis, hyperlipidemia, diabetes, ischemic syndromes and arrhythmias. The Journal is an authoritative source of current and relevant information that is indispensable for basic and clinical investigators aiming for novel, breakthrough research as well as for cardiologists seeking to best serve their patients. Providing you with a single, concise reference tool acknowledged to be among the finest in the world, Cardiovascular Drugs and Therapy is listed in Web of Science and PubMed/Medline among other abstracting and indexing services. The regular articles and frequent special topical issues equip you with an up-to-date source defined by the need for accurate information on an ever-evolving field. Cardiovascular Drugs and Therapy is a careful and accurate guide through the maze of new products and therapies which furnishes you with the details on cardiovascular pharmacology that you will refer to time and time again.