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Systematic review

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Extended Anticoagulation for VTE: A Systematic Review and Meta-Analysis.

Journal Chest
Year 2019
Liens Pubmed DOI

Cet article inclut 16 Primary studies 17 Primary studies (16 references)

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BACKGROUND: The efficacy and safety of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) during extended anticoagulation for a VTE remains largely unknown, especially in terms of potential survival benefit. The goal of this study was to assess the effects of VKAs and DOACs on overall mortality and VTE-related mortality, as well as VTE recurrence and safety. METHODS: PubMed, EMBASE, and the Cochrane Library were searched from January 1990 through September 2018 for randomized controlled trials evaluating the effect of extended anticoagulants as secondary prevention for VTE compared with placebo. The primary outcome was the specific effects of standard-intensity VKAs and DOACs on overall mortality. RESULTS: Sixteen studies (12,458 patients) were included. DOACs were associated with a reduction in overall (risk ratio [RR], 0.48; 95% CI, 0.27-0.86; P = .01) and VTE-related (RR, 0.36; 95% CI, 0.15-0.89; P = .03) mortality, whereas VKAs were not (P > .50). Although VKAs and DOACs similarly prevented recurrent VTE, only VKAs were associated with an increased risk of major bleeding (RR, 2.67; 95% CI, 1.28-5.60; P < .01), resulting in an improved net clinical benefit for DOACs (RR, 0.25 [95% CI, 0.16-0.39; P < .01] vs 0.46 [95% CI, 0.30-0.72; P < .01]; Pinteraction = .05). CONCLUSIONS: DOACs for extended anticoagulation were associated with a significant reduction in overall mortality compared with observation alone. TRIAL REGISTRY: PROSPERO; No.: CRD42018088739; URL: https://www.crd.york.ac.uk/prospero/.

Systematic review

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Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked venous thromboembolism event: systematic review and meta-analysis.

Journal BMJ (Clinical research ed.)
Year 2019
Liens Pubmed DOI PubMed Central

Cet article inclut 18 Primary studies 19 Primary studies (18 references)

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OBJECTIVES: To determine the rate of a first recurrent venous thromboembolism (VTE) event after discontinuation of anticoagulant treatment in patients with a first episode of unprovoked VTE, and the cumulative incidence for recurrent VTE up to 10 years. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, and the Cochrane Central Register of Controlled Trials (from inception to 15 March 2019). STUDY SELECTION: Randomised controlled trials and prospective cohort studies reporting symptomatic recurrent VTE after discontinuation of anticoagulant treatment in patients with a first unprovoked VTE event who had completed at least three months of treatment. DATA EXTRACTION AND SYNTHESIS: Two investigators independently screened studies, extracted data, and appraised risk of bias. Data clarifications were sought from authors of eligible studies. Recurrent VTE events and person years of follow-up after discontinuation of anticoagulant treatment were used to calculate rates for individual studies, and data were pooled using random effects meta-analysis. Sex and site of initial VTE were investigated as potential sources of between study heterogeneity. RESULTS: 18 studies involving 7515 patients were included in the analysis. The pooled rate of recurrent VTE per 100 person years after discontinuation of anticoagulant treatment was 10.3 events (95% confidence interval 8.6 to 12.1) in the first year, 6.3 (5.1 to 7.7) in the second year, 3.8 events/year (95% confidence interval 3.2 to 4.5) in years 3-5, and 3.1 events/year (1.7 to 4.9) in years 6-10. The cumulative incidence for recurrent VTE was 16% (95% confidence interval 13% to 19%) at 2 years, 25% (21% to 29%) at 5 years, and 36% (28% to 45%) at 10 years. The pooled rate of recurrent VTE per 100 person years in the first year was 11.9 events (9.6 to 14.4) for men and 8.9 events (6.8 to 11.3) for women, with a cumulative incidence for recurrent VTE of 41% (28% to 56%) and 29% (20% to 38%), respectively, at 10 years. Compared to patients with isolated pulmonary embolism, the rate of recurrent VTE was higher in patients with proximal deep vein thrombosis (rate ratio 1.4, 95% confidence interval 1.1 to 1.7) and in patients with pulmonary embolism plus deep vein thrombosis (1.5, 1.1 to 1.9). In patients with distal deep vein thrombosis, the pooled rate of recurrent VTE per 100 person years was 1.9 events (95% confidence interval 0.5 to 4.3) in the first year after anticoagulation had stopped. The case fatality rate for recurrent VTE was 4% (95% confidence interval 2% to 6%). CONCLUSIONS: In patients with a first episode of unprovoked VTE who completed at least three months of anticoagulant treatment, the risk of recurrent VTE was 10% in the first year after treatment, 16% at two years, 25% at five years, and 36% at 10 years, with 4% of recurrent VTE events resulting in death. These estimates should inform clinical practice guidelines, enhance confidence in counselling patients of their prognosis, and help guide decision making about long term management of unprovoked VTE. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017056309.

Systematic review

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Prognostic significance of residual venous obstruction in patients with treated unprovoked deep vein thrombosis: a patient-level meta-analysis.

Journal Thrombosis and haemostasis
Year 2014
Liens Pubmed DOI

Cet article inclut 13 Primary studies 13 Primary studies (13 references)

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Residual venous obstruction (RVO) could improve the stratification of the risk of recurrence after unprovoked deep vein thrombosis (DVT), but results from clinical studies and study-level meta-analyses are conflicting. It was the objective of this analysis to determine if RVO is a valid predictor of recurrent venous thromboembolism (VTE) in patients with a first unprovoked DVT who had received at least three months of anticoagulant therapy. Individual patient data were obtained from the datasets of original studies, after a systematic search of electronic databases (Medline, Embase, Cochrane Library), supplemented by manual reviewing of the reference lists and contacting content experts. A multivariate, shared-frailty Cox model was used to calculate hazard ratios (HRs) for recurrent VTE, including, as covariates: RVO; age; sex; anticoagulation duration before RVO assessment; and anticoagulation continuation after RVO assessment. A total of 2,527 patients from 10 prospective studies were included. RVO was found in 1,380 patients (55.1%) after a median of six months from a first unprovoked DVT. Recurrent VTE occurred in 399 patients (15.8%) during a median follow-up of 23.3 months. After multivariate Cox analysis, RVO was independently associated with recurrent VTE (HR = 1.32, 95% confidence interval [CI]: 1.06-1.65). The association was stronger if RVO was detected early, i.e. at three months after DVT (HR = 2.17; 95% CI: 1.11-4.25), but non-significant if detected later, i.e. >6 months (HR = 1.19; 95% CI: 0.87-1.61). In conclusion, after a first unprovoked DVT, RVO is a weak overall predictor of recurrent VTE. The association is stronger if RVO is detected at an earlier time (3 months) after thrombosis.

Systematic review

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Une revue systématique de l'utilité des études résiduels d'obstruction de la veine dans la thrombose veineuse primaire et secondaire.

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Journal Thrombosis
Year 2013
Liens Pubmed DOI PubMed Central

Cet article inclut 13 Primary studies 13 Primary studies (13 references)

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Contexte. Obstruction de la veine résiduelle (RVO), la persistance de la thrombose veineuse avec le temps et souvent après un traitement anticoagulant, peut indiquer un état prothrombotique systémique. Des études antérieures ont montré une efficacité variable en utilisant RVO comme un facteur de risque pour l'avenir thromboembolique veineuse (TEV) de récurrence. Méthodes. Pour évaluer si l'imagerie de RVO positif prévoit d'événements thromboemboliques veineux récurrents, nous avons effectué une méta-analyse sur des études dans lesquelles les patients avec ETV documentés, anticoagulant pour un minimum de 4 semaines, avaient échographie répétée pour évaluer RVO et ont ensuite suivi d'événements récurrents. Résultats. Treize études répondaient aux critères d'inclusion: 3531 événements thromboemboliques veineux des patients avec des résultats évaluables 3474 ont été analysées. La présence de RVO a été associée à la récidive dans tous les TEV (OR 1,93, IC 95%: 1,29, 2,89) et TEV secondaire (OR 2,78, IC 95%: 1,41, 5,5), mais pas de TEV primaire (OR 1,35, IC 95% : 0,87, 2,08). Lorsque les patients atteints de cancer ont été éliminés dans le groupe de la TEV secondaire, il n'y avait plus une association significative de RVO avec TEV récidive (OR 1,73, IC 95%: 0,81, 3,67) alors que dans le sous-ensemble de patients atteints de cancer, la présence de RVO a été associée à une augmentation du risque de récidive de MTEV (OR 5,14, IC 95%: 1,59, 16,65, P <0,006). Conclusions. Nous concluons que la présence de RVO est associé à la récurrence en TEV secondaire mais pas dans la TEV primaire et que l'association peut être entraîné par le sous-ensemble d'un cancer.

Systematic review

Unclassified

Residual venous thrombosis as predictive factor for recurrent venous thromboembolim in patients with proximal deep vein thrombosis: A sytematic review

Auteurs Tan M , Mos IC , Klok FA , Huisman MV
Journal British journal of haematology
Year 2011
Liens Pubmed DOI

Cet article inclut 11 Primary studies 11 Primary studies (11 references)

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The potential role of the detection of residual thrombosis after deep vein thrombosis (DVT) in the differentiation of patients at risk for recurrent venous thromboembolism (VTE) has not yet been fully established and includes different definitions. We performed a systematic review in order to determine the role of residual thrombosis in predicting recurrent VTE after acute proximal DVT. Databases were searched until June 2010. Randomized, controlled trials or prospective cohort studies were eligible for inclusion if they included patients with objectively diagnosed proximal DVT, measured thrombus diameter after at least 3months and reported recurrent VTE during follow-up. Two authors independently reviewed articles and extracted data. Data from 11 studies were used for the current analysis; in total 3203 patients were included. Residual thrombosis was positively correlated with recurrent VTE. Large heterogeneity was present, due to differences in study population, timing and the differences in method of measuring residual thrombosis. The effect was more pronounced in patients with malignancy or was dependent on the criteria used. This systematic review shows a positive relationship between residual thrombosis and recurrent VTE during follow-up. Assessing residual thrombosis could be useful in individual recurrence risk estimation. © 2011 Blackwell Publishing Ltd.

Systematic review

Unclassified

Obstruction de la veine résiduelle pour prédire le risque de thromboembolie veineuse récurrente chez les patients présentant une thrombose veineuse profonde: un examen systématique et une méta-analyse.

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Journal Journal of thrombosis and haemostasis : JTH
Year 2011
Liens Pubmed DOI

Cet article est inclus dans 1 Structured summary of systematic reviews 14 Structured summaries of systematic reviews (1 reference)

Cet article inclut 14 Primary studies 14 Primary studies (14 references)

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LABEL:   CONTEXTE: obstruction de la veine résiduelle (RVO) détectée à l'échographie de compression de la jambe après quelques mois de traitement anticoagulant pourrait être en mesure d'identifier les patients présentant une thrombose veineuse profonde (TVP) à haut risque d'avoir une thrombo-embolie veineuse (TEV) récurrente. But: déterminer si RVO est associée à un risque accru d'événements récurrents chez les patients présentant une TVP. PATIENTS ET MÉTHODES: Une stratégie de recherche systématique de la littérature a été réalisée en utilisant MEDLINE, EMBASE, et le registre Cochrane Controlled Trials. Nous avons sélectionné 14 articles (neuf études de cohortes prospectives et cinq essais contrôlés randomisés) incluant des patients présentant une TVP qui ont eu une évaluation de la RVO avec l'utilisation de l'échographie de compression. Deux examinateurs ont extrait les données sur des formulaires normalisés. RÉSULTATS: Au total, la présence de RVO n'a pas été associés à un risque accru de thromboembolie veineuse récurrente (odds ratio [OR] 1,24, intervalle de confiance à 95% [IC] 0,9 à 1,7) chez les patients présentant une TVP non provoquée qui ont arrêté le traitement anticoagulant par voie orale au moment de RVO évaluation. Toutefois, RVO était significativement associée à la TEV récurrente chez les patients atteints toute TVP (provocation ou provoquée) (OR 1,5, IC 95% 1,1-2,0). CONCLUSIONS: RVO a été associée à un risque légèrement accru de récidive de MTEV chez les patients présentant une TVP (sans provocation et provoqué). Toutefois, RVO ne semble pas être un facteur prédictif de récidive de MTEV chez les patients atteints arrêt TVP anticoagulation provocation suivante. D'autres études prospectives sont nécessaires pour évaluer le rôle de la RVO chez les patients présentant une TVP non provoquée.