Cited by 193Venous Thromboembolism Diagnosis and ManagementAtrial Fibrillation Management and OutcomesBlood Coagulation and Thrombosis Mechanisms

Efficacy and safety outcomes of oral anticoagulants and antiplatelet drugs in the secondary prevention of venous thromboembolism: systematic review and network meta-analysis

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Castellucci, L. A., Cameron, C., Le Gal, G., Rodger, M. A., Coyle, D., Wells, P. S., Clifford, T., Gandara, E. +2 more·2013·BMJ

Abstract

OBJECTIVE: To summarise and compare the efficacy and safety of various oral anticoagulants (dabigatran, rivaroxaban, apixaban, and vitamin K antagonists) and antiplatelet agents (acetylsalicylic acid) for the secondary prevention of venous thromboembolism. DESIGN: Systematic review and network meta-analysis. DATA SOURCES: Literature search using Medline (1950 to present), Embase (1980 to present), and the Cochrane Register of Controlled Trials using the OVID interface. Publications from potentially relevant journals were also searched by hand. REVIEW METHODS: Randomised controlled trials of patients receiving anticoagulants, antiplatelet drugs, or placebo or observation for secondary prevention of venous thromboembolism. Selected outcomes were rates of recurrent venous thromboembolism and major bleeding. Two reviewers independently extracted data onto standardised forms. RESULTS: 12 articles met our inclusion criteria, with 11,999 patients evaluated for efficacy and 12,167 for safety. All treatments reduced the risk of recurrent venous thromboembolism. Compared with placebo or observation, vitamin K antagonists at a standard adjusted dose (target international normalised ratio 2.0-3.0) showed the highest risk difference (odds ratio 0.07; 95% credible interval 0.03 to 0.15) and acetylsalicylic acid showed the lowest risk difference (0.65; 0.39 to 1.03). Risk of major bleeding was higher with a standard adjusted dose of vitamin K antagonists (5.24; 1.78 to 18.25) than with placebo or observation. Fatal recurrent venous thromboembolism and fatal bleeding were rare. Detailed subgroup and individual patient level data were not available. CONCLUSIONS: All oral anticoagulants and antiplatelet agents investigated in this analysis were associated with a reduced recurrence of venous thromboembolism compared with placebo or observation, although acetylsalicylic acid was associated with the lowest risk reduction. Vitamin K antagonists given at a standard adjusted dose was associated with the greatest risk reduction in recurrent venous thromboembolism, but also the greatest risk of major bleeding.

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Authors
Castellucci, L. A., Cameron, C., Le Gal, G., Rodger, M. A., Coyle, D., Wells, P. S., Clifford, T., Gandara, E., Wells, G., & Carrier, M.
Affiliations
  • University of Ottawa (CA)
  • Canada's Drug Agency (CA)
Corresponding author
Carrier, M.
Venue
BMJ
Publisher
BMJ
Published
2013-08-30
Volume
347
Issue
aug30 1
Pages
f5133-f5133
ISSN
1756-1833 (ISSN-L)
OpenAlex
W2007680892
Cited by
193
References
65
Citations by year
2026: 5 · 2025: 10 · 2024: 4 · 2023: 14 · 2022: 9 · 2021: 15 · 2020: 15 · 2019: 14 · 2018: 14 · 2017: 16 · 2016: 25 · 2015: 22 · 2014: 26 · 2013: 4
FWCI
4.79
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
Funders
  • Heart and Stroke Foundation of Canada
  • University of Ottawa
  • Canadian Institutes of Health Research
Topics
  • Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
Keywords
venous thromboembolism, secondary prevention, oral anticoagulants, antiplatelet agents, dabigatran, rivaroxaban, apixaban, vitamin K antagonists, aspirin, recurrent venous thromboembolism, major bleeding, direct oral anticoagulants
MeSH terms
Rivaroxaban, Dabigatran, Anticoagulants, Aspirin, Benzimidazoles, Hemorrhage, Humans, Morpholines, Platelet Aggregation Inhibitors, Pyrazoles, Pyridones, Recurrence, Thiophenes, Vitamin K, beta-Alanine, Venous Thromboembolism

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