Direct oral anticoagulants compared to warfarin in long‐term management of cerebral venous thrombosis: A comprehensive meta‐analysis
Abstract Objectives We compared the safety and efficacy of direct oral anticoagulants (DOACs) with those of warfarin in the long‐term (≥6 months) treatment of cerebral venous thrombosis (CVT). Methods We searched electronic databases up to November 2023 to compare the use of DOACs and warfarin in CV...
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| Format: | Article |
| Language: | English |
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Wiley
2024-02-01
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| Series: | Health Science Reports |
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| Online Access: | https://doi.org/10.1002/hsr2.1869 |
| _version_ | 1797221141472870400 |
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| author | Redoy Ranjan Gie Ken‐Dror Pankaj Sharma |
| author_facet | Redoy Ranjan Gie Ken‐Dror Pankaj Sharma |
| author_sort | Redoy Ranjan |
| collection | DOAJ |
| description | Abstract Objectives We compared the safety and efficacy of direct oral anticoagulants (DOACs) with those of warfarin in the long‐term (≥6 months) treatment of cerebral venous thrombosis (CVT). Methods We searched electronic databases up to November 2023 to compare the use of DOACs and warfarin in CVT management. Modified Rankin scores (mRS), new intracranial hemorrhage, all‐cause mortality, recurrence and nonrecanalisation events were used to assess outcome. RevMan v5.4 software and the Cochran‐Mantel‐Haenszel method were utilized to analyse data. Results A total of 25 studies involving 2301 patients were identified as having treated CVT with either DOACs or warfarin. Good long‐term mRS scores 0–2 (risk ratio [RR] = 1.01, 95% CI = 0.98–1.03; p = 0.61), new intracranial hemorrhage (RR = 1.00, 95% CI = 0.48–2.08; p = 0.99), all‐cause mortality (RR = 1.00, 95% CI = 0.50–1.98; p = 0.99), nonrecanalisation (RR = 0.95, 95% CI = 0.77–1.18; p = 0.65) and recurrence venous thrombosis events (RR = 0.63, 95% CI = 0.33–1.22; p = 0.17) were similar between the two treatment arms. Subgroup analysis found recurrence of venous thrombosis was lower in the rivaroxaban group compared to warfarin (2.2% vs. 8.5%, RR = 0.33, 95% CI = 0.11–0.98; p = 0.05). Conclusion DOACs and warfarin provide comparable long‐term safety and efficacy profiles. DOACs may be preferred over warfarin due to their ease of clinical management. |
| first_indexed | 2024-03-07T19:01:15Z |
| format | Article |
| id | doaj.art-4e866d1d715d4d3cb0703171bf802ba2 |
| institution | Directory Open Access Journal |
| issn | 2398-8835 |
| language | English |
| last_indexed | 2024-04-24T13:00:43Z |
| publishDate | 2024-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Health Science Reports |
| spelling | doaj.art-4e866d1d715d4d3cb0703171bf802ba22024-04-05T11:41:32ZengWileyHealth Science Reports2398-88352024-02-0172n/an/a10.1002/hsr2.1869Direct oral anticoagulants compared to warfarin in long‐term management of cerebral venous thrombosis: A comprehensive meta‐analysisRedoy Ranjan0Gie Ken‐Dror1Pankaj Sharma2Department of Cardiac Surgery Bangabandhu Sheikh Mujib Medical University Dhaka BangladeshInstitute of Cardiovascular Research Royal Holloway University of London (ICR2UL) Greater London UKInstitute of Cardiovascular Research Royal Holloway University of London (ICR2UL) Greater London UKAbstract Objectives We compared the safety and efficacy of direct oral anticoagulants (DOACs) with those of warfarin in the long‐term (≥6 months) treatment of cerebral venous thrombosis (CVT). Methods We searched electronic databases up to November 2023 to compare the use of DOACs and warfarin in CVT management. Modified Rankin scores (mRS), new intracranial hemorrhage, all‐cause mortality, recurrence and nonrecanalisation events were used to assess outcome. RevMan v5.4 software and the Cochran‐Mantel‐Haenszel method were utilized to analyse data. Results A total of 25 studies involving 2301 patients were identified as having treated CVT with either DOACs or warfarin. Good long‐term mRS scores 0–2 (risk ratio [RR] = 1.01, 95% CI = 0.98–1.03; p = 0.61), new intracranial hemorrhage (RR = 1.00, 95% CI = 0.48–2.08; p = 0.99), all‐cause mortality (RR = 1.00, 95% CI = 0.50–1.98; p = 0.99), nonrecanalisation (RR = 0.95, 95% CI = 0.77–1.18; p = 0.65) and recurrence venous thrombosis events (RR = 0.63, 95% CI = 0.33–1.22; p = 0.17) were similar between the two treatment arms. Subgroup analysis found recurrence of venous thrombosis was lower in the rivaroxaban group compared to warfarin (2.2% vs. 8.5%, RR = 0.33, 95% CI = 0.11–0.98; p = 0.05). Conclusion DOACs and warfarin provide comparable long‐term safety and efficacy profiles. DOACs may be preferred over warfarin due to their ease of clinical management.https://doi.org/10.1002/hsr2.1869apixabancerebral venous thrombosisdabigatrandirect oral anticoagulantsedoxabanefficacy |
| spellingShingle | Redoy Ranjan Gie Ken‐Dror Pankaj Sharma Direct oral anticoagulants compared to warfarin in long‐term management of cerebral venous thrombosis: A comprehensive meta‐analysis Health Science Reports apixaban cerebral venous thrombosis dabigatran direct oral anticoagulants edoxaban efficacy |
| title | Direct oral anticoagulants compared to warfarin in long‐term management of cerebral venous thrombosis: A comprehensive meta‐analysis |
| title_full | Direct oral anticoagulants compared to warfarin in long‐term management of cerebral venous thrombosis: A comprehensive meta‐analysis |
| title_fullStr | Direct oral anticoagulants compared to warfarin in long‐term management of cerebral venous thrombosis: A comprehensive meta‐analysis |
| title_full_unstemmed | Direct oral anticoagulants compared to warfarin in long‐term management of cerebral venous thrombosis: A comprehensive meta‐analysis |
| title_short | Direct oral anticoagulants compared to warfarin in long‐term management of cerebral venous thrombosis: A comprehensive meta‐analysis |
| title_sort | direct oral anticoagulants compared to warfarin in long term management of cerebral venous thrombosis a comprehensive meta analysis |
| topic | apixaban cerebral venous thrombosis dabigatran direct oral anticoagulants edoxaban efficacy |
| url | https://doi.org/10.1002/hsr2.1869 |
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