title: Direct oral anticoagulants compared with vitamin K antagonists for acute venous thromboembolism: evidence from phase 3 trials.
abstract: In the last 4 years, 6 phase 3 trials including a total of 27,023 patients with venous thromboembolism (VTE) compared a direct oral anticoagulant (DOAC) with vitamin K antagonists (VKAs). To aid the clinician in assessing the amount of information, we address frequently raised clinical questions in a review of combined trial results. We included the phase 3 trials that compared dabigatran etexilate, rivaroxaban, apixaban, or edoxaban with VKA therapy in patients with acute symptomatic VTE. Recurrent VTE occurred in 2.0% of DOAC recipients compared with 2.2% in VKA recipients (relative risk [RR] 0.90, 95% confidence interval [CI] 0.77-1.06). Treatment with a DOAC significantly reduced the risk of major bleeding (RR 0.61, 95% CI 0.45-0.83). In parallel, intracranial bleeding, fatal bleeding, and clinically relevant nonmajor bleeding occurred significantly less in DOAC recipients. The efficacy and safety of DOACs were consistent in patients with pulmonary embolism, deep venous thrombosis, a body weight ≥100 kg, moderate renal insufficiency, an age ≥75 years, and cancer. In conclusion, DOACs and VKAs have similar efficacy in the treatment of acute symptomatic VTE, a finding that is consistent in key clinical subgroups. Treatment with a DOAC significantly reduces the risks of major bleeding.
authors: Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands; and.
authors: Nick
authors: N
authors: van Es
authors: Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands; and.
authors: Michiel
authors: M
authors: Coppens
authors: Department of Medicine, McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada.
authors: Sam
authors: S
authors: Schulman
authors: Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands; and.
authors: Saskia
authors: S
authors: Middeldorp
authors: Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands; and.
authors: Harry R
authors: HR
authors: Büller
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001562:Benzimidazoles / Q000008:administration & dosage; D017326:Clinical Trials, Phase III as Topic; D000069604:Dabigatran; D065427:Factor Xa Inhibitors / Q000008:administration & dosage; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D009025:Morpholines / Q000008:administration & dosage; D011720:Pyrazoles / Q000008:administration & dosage; D011725:Pyridines / Q000008:administration & dosage; D011728:Pyridones / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D000069552:Rivaroxaban; D013844:Thiazoles / Q000008:administration & dosage; D013876:Thiophenes / Q000008:administration & dosage; D054556:Venous Thromboembolism / Q000188:drug therapy*; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D065427:Factor Xa Inhibitors; D009025:Morpholines; D011720:Pyrazoles; D011725:Pyridines; D011728:Pyridones; D013844:Thiazoles; D013876:Thiophenes; D014812:Vitamin K; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran; C552171:edoxaban