Chen Jiana, Lv Meina, Jiang Shaojun, Wu Shuyi, Xu Wenlin, Qian Jiafen, Zeng Zhiwei, Chen Mingrong, Fang Zongwei, Zhang Jinhua
Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.
Vasc Med. 2022 Dec;27(6):565-573. doi: 10.1177/1358863X221115213. Epub 2022 Sep 5.
Direct oral anticoagulants (DOACs) are associated with bleeding. Patients often stop taking DOACs due to nonmajor bleeding, which may lead to venous thromboembolism (VTE) recurrence. We aimed to determine the risk of nonmajor bleeding using different DOACs to prevent and treat VTE.
PubMed, Embase, Web of Science, and Cochrane Library databases were searched from inception until January 6, 2021. The incidence of clinically relevant nonmajor bleeding and minor bleeding was investigated. In frequentist-based network meta-analysis, we analyzed the odds ratio (OR) with 95% CI and the surface under the cumulative ranking curves (SUCRA).
Twenty-seven randomized controlled trials (RCTs) (involving 64,493 patients) were included. For preventing VTE, the risk for clinically relevant nonmajor bleeding was lowest for apixaban, followed by that for low-molecular weight heparin (LMWH), dabigatran, edoxaban, and rivaroxaban. The risk for minor bleeding was lowest for apixaban, followed by that for rivaroxaban, LMWH, dabigatran, and edoxaban. For treating VTE, the risk for clinically relevant nonmajor bleeding was also lowest for apixaban, followed by that for edoxaban, vitamin K antagonists (VKAs), and rivaroxaban. The risk for minor bleeding was lowest for apixaban, followed by that for rivaroxaban and VKAs.
Regardless of whether it was used for preventing or treating VTE, apixaban had the lowest risk of nonmajor bleeding. This suggests that apixaban may have a lower risk of nonmajor bleeding than other anticoagulants and may help provide some clinical reference for choosing a more appropriate drug for the patient.
直接口服抗凝剂（DOACs）与出血相关。患者常因非大出血而停用DOACs，这可能导致静脉血栓栓塞（VTE）复发。我们旨在确定使用不同DOACs预防和治疗VTE时非大出血的风险。
检索PubMed、Embase、Web of Science和Cochrane图书馆数据库，检索时间从数据库创建至2021年1月6日。调查临床相关非大出血和小出血的发生率。在基于频率的网络荟萃分析中，我们分析了比值比（OR）及95%置信区间（CI）和累积排序曲线下面积（SUCRA）。
纳入27项随机对照试验（RCT）（涉及64493例患者）。对于预防VTE，阿哌沙班发生临床相关非大出血的风险最低，其次是低分子量肝素（LMWH）、达比加群、依度沙班和利伐沙班。小出血风险最低的是阿哌沙班，其次是利伐沙班、LMWH、达比加群和依度沙班。对于治疗VTE，阿哌沙班发生临床相关非大出血的风险也最低，其次是依度沙班、维生素K拮抗剂（VKAs）和利伐沙班。小出血风险最低的是阿哌沙班，其次是利伐沙班和VKAs。
无论用于预防还是治疗VTE，阿哌沙班发生非大出血的风险最低。这表明阿哌沙班发生非大出血的风险可能低于其他抗凝剂，可能有助于为为患者选择更合适的药物提供一些临床参考。
