EFFICACY AND SAFETY OF THE ORAL ANTICOAGULANTS IN THE MANAGEMENT OF VENOUS THROMBOEMBOLISM: INDIRECT COMPARISON
Abstract
Objective. The aim was to perform an indirect comparisons of the effectiveness and safety of new oral anticoagulants (NOACs) in the management of venous thromboembolism (VTE).
Material and methods. In the absence of a head-to-head comparisons, indirect comparison was done using the method proposed by Butcher et al.
Results. The indirect comparison included 5 RCTs. Apixaban, rivaroxaban and dabigatran were equally effective in preventing recurrent symptomatic VTE, deep vein thrombosis and pulmonary embolism. Dabigatran increased major bleeding risk compared to apixaban RR=2.36; 95% CI 1.15-4.82 and the risk major or clinical relevant non-major (CRNM) bleedings RR=1.43; 95% CI 1.06-1.93. Dabigatran and apixaban were associated with the significant lower risk of major and CRNM bleeding compared with rivaroxaban RR=1.49; 95% CI 1.17-1.91 and RR=2.13; 95% CI 1.66-2.74.
Conclusions. There were no statistically significant differences between apixaban, dabigatran and rivaroxaban in effectiveness. Apixaban treatment associated with the most favorable safety profile of the NOACs.
About the Authors
V. I. Petrov
Volgograd State Medical University of the Ministry of Health Russian Federation
Russian Federation
Russian Federation
Academician, MD, Professor, Head of the Department of Clinical Pharmacology and Intensive Therapy, Volgograd State Medical University of the Ministry of Health Russian Federation. Address: pl. Pavshikh Bortsov, 1, g. Volgograd, 400131. Tel.: +7 (8442)385005
O. V. Shatalova
Volgograd State Medical University of the Ministry of Health Russian Federation
Russian Federation
Russian Federation
PhD, assistant of the department of clinical pharmacology and intensive Therapy, Volgograd State Medical University of the Ministry of Health Russian Federation. Address: pl. Pavshikh Bortsov, 1, g. Volgograd, 400131. Tel.: +7 (8442)385005
V. S. Gorbatenko
Volgograd State Medical University of the Ministry of Health Russian Federation
Russian Federation
Russian Federation
graduate student of the Department of Clinical Pharmacology and Intensive Therapy, Volgograd State Medical University of the Ministry of Health Russian Federation. Address: pl. Pavshikh Bortsov, 1, g. Volgograd, 400131. Tel.: +7 (8442)385005
D. V. Frolov
Volgograd State Medical University of the Ministry of Health Russian Federation
Russian Federation
Russian Federation
MD, assistant professor of general surgery with urology, Volgograd State Medical University of the Ministry of Health Russian Federation. Address: pl. Pavshikh Bortsov, 1, g. Volgograd, 400131. Tel.: +7 (8442)385005
E. A. Ponomarev
Volgograd State Medical University of the Ministry of Health Russian Federation
Russian Federation
Russian Federation
MD, professor of surgery hospital, Volgograd State Medical University of the Ministry of Health Russian Federation. Address: pl. Pavshikh Bortsov, 1, g. Volgograd, 400131. Tel.: +7 (8442)385005
A. S. Maslakov
Volgograd State Medical University of the Ministry of Health Russian Federation
Russian Federation
Russian Federation
graduate student of the Department of Clinical Pharmacology and Intensive Therapy, Volgograd State Medical University of the Ministry of Health Russian Federation. Address: pl. Pavshikh Bortsov, 1, g. Volgograd, 400131. Tel.: +7 (8442)385005
References
1. State Register of medicines [Gosudarstvennyi reestr lekarstvennykh sredstv (in Russian)]. URL: http://grls.rosminzdrav.ru/. Accessed: 15.01.16.
2. Kirienko A. I. Flebologiya. 2015; 4 (2): 52s.
3. Petrov V. I., Maslakov A. S., Shatalova O. V. Vestnik Volgogradskogo gosudarstvennogo meditsinskogo universiteta. 2013; 4: 12-15.
4. Petrov V. I., Shatalova O. V., Maslakov A. S. Kardiovaskulyarnaya terapiya i profilaktika. 2014; 4: 54-59.
5. Agnelli G., Buller H. R., Cohen A. et al. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med. 2013; 369: 799-808.
6. Bucher H. C., Guyatt G. H ., Griffi th L. E ., Walter S. D. The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J. Clin. Epidemiol. 1997; 50: 683-691.
7. Schulman S., Kearon C., Kakkar A. K. et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med. 2009; 361: 2342-2352.
8. Schulman S., Kakkar A. K., Goldhaber S. Z. et al. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation. 2014; 129: 764-772.
9. The EINSTEIN Investigators. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010; 363: 2499-2510.
10. The EINSTEINePE Investigators. Oral rivaroxaban for the treatment of symp-tomatic pulmonary embolism. N Engl J Med. 2012; 366: 1287-1297.
For citation:
Petrov V.I., Shatalova O.V., Gorbatenko V.S., Frolov D.V., Ponomarev E.A., Maslakov A.S. EFFICACY AND SAFETY OF THE ORAL ANTICOAGULANTS IN THE MANAGEMENT OF VENOUS THROMBOEMBOLISM: INDIRECT COMPARISON. FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology. 2016;9(3):3-7. (In Russ.) https://doi.org/10.17749/2070-4909.2016.9.3.003-007
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