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Internal and Emergency Medicine

, Volume 10, Issue 4, pp 499–506 | Cite as

New oral anticoagulants for the treatment of acute venous thromboembolism: are they safer than vitamin K antagonists? A meta-analysis of the interventional trials

  • Lorenzo LoffredoEmail author
  • Ludovica Perri
  • Maria Del Ben
  • Francesco Angelico
  • Francesco Violi
CE-ORIGINAL

Abstract

New oral anticoagulants (NOACs) may represent an alternative to standard therapy with vitamin K antagonists (VKA). However, up to the present, it is unknown whether these drugs are safer than VKA. The aim of this study was to perform a meta-analysis of the interventional trials with NOACs vs VKA in patients with acute venous thromboembolism (VTE) to obtain the balance between clinical efficacy and complications. A meta-analysis of double blind randomized controlled trials (RCTs) was performed. We included RCTs that compared, in acute VTE, the beneficial and harmful effects of NOACs (ximelagatran, apixaban, dabigatran, edoxaban and rivaroxaban) vs VKA (warfarin). Seven studies including 29,482 patients were selected. Compared with warfarin, recurrent VTE and death from any cause were not significantly reduced by NOACs. Myocardial infarction was significantly increased with NOACs compared with warfarin (RR 2.55; 95 % CI 1.1–5.6; p = 0.02). NOACs significantly reduced the major bleedings (RR 0.63; 95 % CI 0.47–0.83; p = 0.001). This meta-analysis suggests that treatment with NOACs in patients with acute VTE is not inferior to conventional therapy with warfarin for recurrent VTE and death from any cause, but there might be an increased incidence of myocardial infarction.

Keywords

New oral anticoagulants Venous thrombosis Myocardial infarction 

Notes

Conflict of interest

None.

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Copyright information

© SIMI 2014

Authors and Affiliations

  • Lorenzo Loffredo
    • 1
  • Ludovica Perri
    • 1
  • Maria Del Ben
    • 1
  • Francesco Angelico
    • 2
  • Francesco Violi
    • 1
  1. 1.Dipartimento di Medicina Interna e Specialità Mediche, I Clinica MedicaUniversity of Rome “La Sapienza”RomeItaly
  2. 2.Dipartimento di Igiene e Sanità PubblicaUniversity of Rome “La Sapienza”RomeItaly

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