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Direct oral anticoagulants vs. vitamin K antagonists in patients with antiphospholipid syndrome: a systematic review and meta-analysis
Optimal treatment regimen for patients with antiphospholipid syndrome (APS) remain unclear. Therefore, the authors sought to compare the outcomes of vitamin K antagonists (VKAs) vs. direct oral anticoagulants (DOACs) in patients with APS. METHODS: MEDLINE, Embase, and Cochrane Central databases were...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10328675/ https://www.ncbi.nlm.nih.gov/pubmed/37427194 http://dx.doi.org/10.1097/MS9.0000000000000903 |
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author | Shah, Bidhan Bikram Shankar, Abhirami Kumar, Vinesh Kumar, Sumeet Malik, Umair Arshad Majeed, Abdul Kumar, Vijay Berkha Suman Kumar, Sumeet Netha, Aadarsh Subedi, Sonika Ahmed, Shoaib |
author_facet | Shah, Bidhan Bikram Shankar, Abhirami Kumar, Vinesh Kumar, Sumeet Malik, Umair Arshad Majeed, Abdul Kumar, Vijay Berkha Suman Kumar, Sumeet Netha, Aadarsh Subedi, Sonika Ahmed, Shoaib |
author_sort | Shah, Bidhan Bikram |
collection | PubMed |
description | Optimal treatment regimen for patients with antiphospholipid syndrome (APS) remain unclear. Therefore, the authors sought to compare the outcomes of vitamin K antagonists (VKAs) vs. direct oral anticoagulants (DOACs) in patients with APS. METHODS: MEDLINE, Embase, and Cochrane Central databases were searched for randomized controlled trials comparing efficacy and safety of VKAs and DOACs inhibitors in patients with APS. Recurrent thrombosis, all-cause mortality, stroke, adverse reactions, and bleeding were among outcomes of interest. Mantel–Haenszel weighted random-effects model was used to calculate relative risks (RRs) with 95% CIs. RESULTS: The analysis included 625 patients from four randomized controlled trials and one post hoc analysis. Meta-analysis showed statistically non-significant difference between DOACs inhibitors and VKAs in the recurrent thrombosis risk (arterial or venous) [RR 2.77 (95%, CI 0.79, 9.65); P=0.11, I(2)=50%]. Consistent results were revealed among patients with the previous history of arterial thrombosis [RR 2.76 (95% CI 0.93, 8.16); P=0.75, I(2)=0%], venous thrombosis [RR 1.71 (95% CI 0.60, 4.84); P=0.31, I(2)=15%] and patients who were triple antiphospholipid positive [RR 4.12 (95% CI 0.46, 37.10); P=0.21, I(2)=58%]. DOACs inhibitors were significantly associated with increased risk of stroke [RR 8.51 (95% CI 2.35, 3.82); P=0.47, I(2)=0%]. CONCLUSION: DOACs exhibited increased risk of stroke among patients with APS. In addition, although not significant, the higher RRs among patients on DOACs may indicate higher risk of thrombotic events associated with DOACs. |
format | Online Article Text |
id | pubmed-10328675 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-103286752023-07-08 Direct oral anticoagulants vs. vitamin K antagonists in patients with antiphospholipid syndrome: a systematic review and meta-analysis Shah, Bidhan Bikram Shankar, Abhirami Kumar, Vinesh Kumar, Sumeet Malik, Umair Arshad Majeed, Abdul Kumar, Vijay Berkha Suman Kumar, Sumeet Netha, Aadarsh Subedi, Sonika Ahmed, Shoaib Ann Med Surg (Lond) Review Articles Optimal treatment regimen for patients with antiphospholipid syndrome (APS) remain unclear. Therefore, the authors sought to compare the outcomes of vitamin K antagonists (VKAs) vs. direct oral anticoagulants (DOACs) in patients with APS. METHODS: MEDLINE, Embase, and Cochrane Central databases were searched for randomized controlled trials comparing efficacy and safety of VKAs and DOACs inhibitors in patients with APS. Recurrent thrombosis, all-cause mortality, stroke, adverse reactions, and bleeding were among outcomes of interest. Mantel–Haenszel weighted random-effects model was used to calculate relative risks (RRs) with 95% CIs. RESULTS: The analysis included 625 patients from four randomized controlled trials and one post hoc analysis. Meta-analysis showed statistically non-significant difference between DOACs inhibitors and VKAs in the recurrent thrombosis risk (arterial or venous) [RR 2.77 (95%, CI 0.79, 9.65); P=0.11, I(2)=50%]. Consistent results were revealed among patients with the previous history of arterial thrombosis [RR 2.76 (95% CI 0.93, 8.16); P=0.75, I(2)=0%], venous thrombosis [RR 1.71 (95% CI 0.60, 4.84); P=0.31, I(2)=15%] and patients who were triple antiphospholipid positive [RR 4.12 (95% CI 0.46, 37.10); P=0.21, I(2)=58%]. DOACs inhibitors were significantly associated with increased risk of stroke [RR 8.51 (95% CI 2.35, 3.82); P=0.47, I(2)=0%]. CONCLUSION: DOACs exhibited increased risk of stroke among patients with APS. In addition, although not significant, the higher RRs among patients on DOACs may indicate higher risk of thrombotic events associated with DOACs. Lippincott Williams & Wilkins 2023-05-25 /pmc/articles/PMC10328675/ /pubmed/37427194 http://dx.doi.org/10.1097/MS9.0000000000000903 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (https://creativecommons.org/licenses/by-nc/4.0/) (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) |
spellingShingle | Review Articles Shah, Bidhan Bikram Shankar, Abhirami Kumar, Vinesh Kumar, Sumeet Malik, Umair Arshad Majeed, Abdul Kumar, Vijay Berkha Suman Kumar, Sumeet Netha, Aadarsh Subedi, Sonika Ahmed, Shoaib Direct oral anticoagulants vs. vitamin K antagonists in patients with antiphospholipid syndrome: a systematic review and meta-analysis |
title | Direct oral anticoagulants vs. vitamin K antagonists in patients with antiphospholipid syndrome: a systematic review and meta-analysis |
title_full | Direct oral anticoagulants vs. vitamin K antagonists in patients with antiphospholipid syndrome: a systematic review and meta-analysis |
title_fullStr | Direct oral anticoagulants vs. vitamin K antagonists in patients with antiphospholipid syndrome: a systematic review and meta-analysis |
title_full_unstemmed | Direct oral anticoagulants vs. vitamin K antagonists in patients with antiphospholipid syndrome: a systematic review and meta-analysis |
title_short | Direct oral anticoagulants vs. vitamin K antagonists in patients with antiphospholipid syndrome: a systematic review and meta-analysis |
title_sort | direct oral anticoagulants vs. vitamin k antagonists in patients with antiphospholipid syndrome: a systematic review and meta-analysis |
topic | Review Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10328675/ https://www.ncbi.nlm.nih.gov/pubmed/37427194 http://dx.doi.org/10.1097/MS9.0000000000000903 |
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