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Direct oral anticoagulants in patients with venous thromboembolism and thrombophilia: a systematic review and meta‐analysis.

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  • معلومة اضافية
    • Author-Supplied Keywords:
      direct factor Xa inhibitors
      direct oral anticoagulants
      direct thrombin inhibitors
      hypercoagulability
      thrombophilia
      venous thromboembolism
    • Abstract:
      EssentialsWe investigated direct oral anticoagulant (DOAC) use in venous thromboembolism and thrombophilia.A comprehensive search identified 10 studies, 8 of which were included in a meta‐analysis.DOACs were overall safe and effective in patients with venous thromboembolism and thrombophilia.Efficacy/safety of DOACs was maintained in low‐risk antiphospholipid syndrome patient subgroup. Summary: Background: Direct oral anticoagulants (DOACs) are increasingly used in acute and long‐term treatment of venous thromboembolism (VTE). However, their role in management of thrombophilia‐associated VTE is controversial. Methods: Through a comprehensive search on MEDLINE, Cochrane Library, and Clinicaltrials.gov, we identified 10 eligible studies, 8 of which reporting data on 1994 thrombophilia patients were included in a random‐effects meta‐analysis. Eligible studies were phase 2 to 3 randomized controlled trials comparing DOACs to vitamin K antagonists (VKAs) in patients with VTE, including those with thrombophilia. Results: Of eight studies included in meta‐analysis, four evaluated rivaroxaban, three dabigatran, and one edoxaban. No results could be obtained on apixaban use. The rates of VTE recurrence (RR, 0.70; 95% CI, 0.34–1.44; I2 = 0%) and major/clinically relevant non‐major bleeding events (RR, 0.92; 95% CI, 0.62–1.36; I2 = 23%) were similar between thrombophilia patients treated with DOACs compared to VKAs. Results were comparable to findings in patients without known thrombophilia: RR, 1.02; 95% CI, 0.80–1.30; I2 = 46% for VTE recurrence and RR, 0.72; 95% CI, 0.57–0.90; I2 = 84% for major/clinically relevant non‐major bleeding events. Conclusions: Rates of VTE recurrence and bleeding events were both low and comparable in patients with various thrombophilias receiving either treatment, suggesting that DOACs are an appropriate treatment option in this population. Due to limited data, it is unclear whether these findings apply to specific subgroups such as high‐risk antiphospholipid syndrome, uncommon thrombophilias, or the use of apixaban. [ABSTRACT FROM AUTHOR]
    • Abstract:
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    • Author Affiliations:
      1Faculty of Medicine, Ain Shams University, Cairo Egypt
      2Department of Vascular Medicine, Academic Medical Center, Amsterdam the Netherlands
      3Winship Cancer Institute of Emory University, Atlanta GA, USA
    • Full Text Word Count:
      6433
    • ISSN:
      1538-7933
    • Accession Number:
      10.1111/jth.14398
    • Accession Number:
      135669090
  • Citations
    • ABNT:
      ELSEBAIE, M. A. T. et al. Direct oral anticoagulants in patients with venous thromboembolism and thrombophilia: a systematic review and meta‐analysis. Journal of Thrombosis & Haemostasis, [s. l.], v. 17, n. 4, p. 645–656, 2019. DOI 10.1111/jth.14398. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=asn&AN=135669090&custid=s8280428. Acesso em: 4 ago. 2020.
    • AMA:
      Elsebaie MAT, Es N, Langston A, Büller HR, Gaddh M. Direct oral anticoagulants in patients with venous thromboembolism and thrombophilia: a systematic review and meta‐analysis. Journal of Thrombosis & Haemostasis. 2019;17(4):645-656. doi:10.1111/jth.14398.
    • AMA11:
      Elsebaie MAT, Es N, Langston A, Büller HR, Gaddh M. Direct oral anticoagulants in patients with venous thromboembolism and thrombophilia: a systematic review and meta‐analysis. Journal of Thrombosis & Haemostasis. 2019;17(4):645-656. doi:10.1111/jth.14398
    • APA:
      Elsebaie, M. A. T., Es, N., Langston, A., Büller, H. R., & Gaddh, M. (2019). Direct oral anticoagulants in patients with venous thromboembolism and thrombophilia: a systematic review and meta‐analysis. Journal of Thrombosis & Haemostasis, 17(4), 645–656. https://doi.org/10.1111/jth.14398
    • Chicago/Turabian: Author-Date:
      Elsebaie, Maha A. T., Nick Es, Amelia Langston, Harry R. Büller, and Manila Gaddh. 2019. “Direct Oral Anticoagulants in Patients with Venous Thromboembolism and Thrombophilia: A Systematic Review and Meta‐analysis.” Journal of Thrombosis & Haemostasis 17 (4): 645–56. doi:10.1111/jth.14398.
    • Harvard:
      Elsebaie, M. A. T. et al. (2019) ‘Direct oral anticoagulants in patients with venous thromboembolism and thrombophilia: a systematic review and meta‐analysis’, Journal of Thrombosis & Haemostasis, 17(4), pp. 645–656. doi: 10.1111/jth.14398.
    • Harvard: Australian:
      Elsebaie, MAT, Es, N, Langston, A, Büller, HR & Gaddh, M 2019, ‘Direct oral anticoagulants in patients with venous thromboembolism and thrombophilia: a systematic review and meta‐analysis’, Journal of Thrombosis & Haemostasis, vol. 17, no. 4, pp. 645–656, viewed 4 August 2020, .
    • MLA:
      Elsebaie, Maha A. T., et al. “Direct Oral Anticoagulants in Patients with Venous Thromboembolism and Thrombophilia: A Systematic Review and Meta‐analysis.” Journal of Thrombosis & Haemostasis, vol. 17, no. 4, Apr. 2019, pp. 645–656. EBSCOhost, doi:10.1111/jth.14398.
    • Chicago/Turabian: Humanities:
      Elsebaie, Maha A. T., Nick Es, Amelia Langston, Harry R. Büller, and Manila Gaddh. “Direct Oral Anticoagulants in Patients with Venous Thromboembolism and Thrombophilia: A Systematic Review and Meta‐analysis.” Journal of Thrombosis & Haemostasis 17, no. 4 (April 2019): 645–56. doi:10.1111/jth.14398.
    • Vancouver/ICMJE:
      Elsebaie MAT, Es N, Langston A, Büller HR, Gaddh M. Direct oral anticoagulants in patients with venous thromboembolism and thrombophilia: a systematic review and meta‐analysis. Journal of Thrombosis & Haemostasis [Internet]. 2019 Apr [cited 2020 Aug 4];17(4):645–56. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=asn&AN=135669090&custid=s8280428