Venous Thromboembolism: Review Compares Eight Treatment Options

Dr. Marc Carrier, MD MSc Scientist, Clinical Epidemiology, Ottawa Hospital Research Institute Physician, Hematology (Thrombosis), The Ottawa Hospital Associate Professor, Department of Medicine, Faculty of Medicine, and Research Chair in Venous Thromboembolism and Cancer (Tier 2) at the University of Ottawa MedicalResearch.com Interview with:
Dr. Marc Carrier, MD MSc
Scientist, Clinical Epidemiology, Ottawa Hospital Research Institute
Physician, Hematology, The Ottawa Hospital
Associate Professor, Department of Medicine, Faculty of Medicine, and Research Chair in Venous Thromboembolism and Cancer (Tier 2) at the University of Ottawa

MedicalResearch.com: What are the main findings of this study?

Dr. Carrier: Venous thromboembolism (VTE), comprised of deep vein thrombosis and pulmonary embolism, is the third leading cause of cardiovascular death. There are many anticoagulant treatments available but there is little guidance about which treatment is most effective and safe. This systematic review and network meta-analysis evaluated eight different treatment options for acute Venous thromboembolism. Forty-five trials were included in the analysis and there were no significant differences in clinical or safety outcomes associated with most treatment options when compared to the combination of LMWH-VKA..

Medical Research: What are the main findings of the study?

Dr. Carrier: The combination of UFH-VKA was the least effective treatment with 1.84% of patients experiencing recurrent VTE in the first 3 months, compared to 1.3% for patients treated with LMWH-VKA combination. Rivaroxaban and apixaban were associated with the lowest risk of bleeding compared to LMWH-VKA combination, 0.49%, 0.29% and 0.89%, respectively, in the first 3 months of treatment. All other treatment options demonstrated similar efficacy and safety as the combination of LMWH-VKA.

Medical Research: What should clinicians and patients take away from your report?

Dr. Carrier: These data provide clinicians with much needed information regarding which anticoagulation regimens are effective and safe for treatment of acute Venous thromboembolism. While all treatment options, with the exception of UFH-VKA combination, demonstrated no difference in rates of recurrent venous thromboembolism events or bleeding risk compared to LMWH-VKA combination, these data should be interpreted cautiously given the lack of direct comparison between treatments. Patient preferences for treatment options should also be considered.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Carrier: Areas for future study including direct comparison trials, patient-level network meta-analyses, or high quality non-randomized studies, are needed to confirm our findings. Future studies are also needed to determine which treatment options are most cost effective.

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