Evaluating the efficacy and safety of apixaban, a new oral anticoagulant, using Bayesian meta-analysis.
Apixaban is a direct inhibitor of factor Xa, and is a potential alternative for the treatment of acute venous thromboembolism. This study sought to evaluate the efficacy and safety of apixaban versus enoxaparin. A systematic search of the literature for randomized controlled trials of apixaban thromboprophylaxis versus enoxaparin was conducted using three databases: PubMed, EMBASE, and the Cochrane library. Five studies that included a total of 12,938 patients were analyzed using Bayesian random-effects meta-analysis. To evaluate efficacy, a composite of venous thromboembolism and death during follow-up was measured. To evaluate safety, major and total bleeding events were considered. The odds ratio (OR) for the composite outcome of efficacy was 0.66 (95 % CI 0.33-1.29) for apixaban compared to enoxaparin, while there was a similar risk of major bleeding (OR 1.03, 95 % CI 0.36-3.73) and total bleeding (OR 0.92, 95 % CI 0.64-1.20). These results suggest a lack of clear superiority of apixaban relative to enoxaparin. Apixaban is an oral alternative with similar efficacy and safety to existing anticoagulant therapies.
Department of Pharmacy Practice and Science, The University of Arizona, College of Pharmacy, 1295 North Martin Avenue, Tucson, AZ, 85721, USA, villa@pharmacy.arizona.edu.
Lorenzo A
LA
Villa
Daniel C
DC
Malone
Daniel
D
Ross
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D001499:Bayes Theorem; D002423:Cause of Death; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D016017:Odds Ratio; D017594:Publication Bias; D011720:Pyrazoles / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D011728:Pyridones / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D013923:Thromboembolism / Q000188:drug therapy / Q000401:mortality; D013927:Thrombosis / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome
D000925:Anticoagulants; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban