Anticoagulant for treatment and prophylaxis of venous thromboembolism patients with renal dysfunction: A systematic review and network meta-analysis
ObjectiveThe aim of this study was to compare the efficacy and safety for particular regimen and dosage in venous thromboembolism (VTE) patients with renal insufficiency.MethodsEnglish language searches of PubMed, Embase, and Web of Science (inception to May 2021). RCTs evaluating anticoagulants for...
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Frontiers Media S.A.
2022-09-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.979911/full |
| _version_ | 1818017224226504704 |
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| author | Guohui Fan Guohui Fan Guohui Fan Guohui Fan Dingyi Wang Dingyi Wang Dingyi Wang Dingyi Wang Meng Zhang Xufei Luo Zhenguo Zhai Zhenguo Zhai Zhenguo Zhai Zhenguo Zhai Sinan Wu Sinan Wu Sinan Wu Sinan Wu |
| author_facet | Guohui Fan Guohui Fan Guohui Fan Guohui Fan Dingyi Wang Dingyi Wang Dingyi Wang Dingyi Wang Meng Zhang Xufei Luo Zhenguo Zhai Zhenguo Zhai Zhenguo Zhai Zhenguo Zhai Sinan Wu Sinan Wu Sinan Wu Sinan Wu |
| author_sort | Guohui Fan |
| collection | DOAJ |
| description | ObjectiveThe aim of this study was to compare the efficacy and safety for particular regimen and dosage in venous thromboembolism (VTE) patients with renal insufficiency.MethodsEnglish language searches of PubMed, Embase, and Web of Science (inception to May 2021). RCTs evaluating anticoagulants for VTE treatment at acute phase, extension phase, and VTE prophylaxis in patients with renal insufficiency and reporting efficacy (death, recurrence, or occurrence of VTE) and safety (bleeding) outcomes were selected. The methodological quality of each study included was assessed at the outcome level using the risk-of-bias assessment tool developed by the Cochrane Bias Methods Group.ResultsTwenty-one trials that involved 76,574 participants and 8,972 (11.7%) patients with renal insufficiency were enrolled, including 10 trials on VTE treatment in acute phase (3–12 months), four trials on VTE treatment in extension phase (6–36 months), and seven trials for VTE prophylaxis. For acute VTE treatment, compared with dabigatran etexilate, apixaban (RR 5.90, 95%CI 1.00–34.60) and rivaroxaban (RR 6.18, 95%CI 1.17–32.75) were significantly associated with increased risk of death or recurrence. For extension treatment of VTE, aspirin had the highest probability of the most effective and safest treatment, followed by apixaban. For VTE prophylaxis, compared with enoxaparin, desirudin was associated with lower risk of VTE occurrence (RR 0.56, 95% CI 0.34–0.91), but had higher risk of bleeding than dabigatran etexilate.ConclusionThe network meta-analysis informs the optimal choice of anticoagulants and their particular dosage for treatment and prophylaxis of VTE patients comorbid renal insufficiency.Systematic review registrationwww.crd.york.ac.uk/prospero/, identifier: CRD42021254086. |
| first_indexed | 2024-04-14T07:24:33Z |
| format | Article |
| id | doaj.art-566703b9868b47bca0c87c1bd0b26acc |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-04-14T07:24:33Z |
| publishDate | 2022-09-01 |
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| series | Frontiers in Medicine |
| spelling | doaj.art-566703b9868b47bca0c87c1bd0b26acc2022-12-22T02:06:03ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-09-01910.3389/fmed.2022.979911979911Anticoagulant for treatment and prophylaxis of venous thromboembolism patients with renal dysfunction: A systematic review and network meta-analysisGuohui Fan0Guohui Fan1Guohui Fan2Guohui Fan3Dingyi Wang4Dingyi Wang5Dingyi Wang6Dingyi Wang7Meng Zhang8Xufei Luo9Zhenguo Zhai10Zhenguo Zhai11Zhenguo Zhai12Zhenguo Zhai13Sinan Wu14Sinan Wu15Sinan Wu16Sinan Wu17Department of Clinical Research and Data Management, China-Japan Friendship Hospital, Beijing, ChinaNational Center for Respiratory Disease, Beijing, ChinaNational Clinical Research Center for Respiratory Disease, Beijing, ChinaInstitute of Respiratory Medicine, Chinses Academy of Medical Sciences, Beijing, ChinaDepartment of Clinical Research and Data Management, China-Japan Friendship Hospital, Beijing, ChinaNational Center for Respiratory Disease, Beijing, ChinaNational Clinical Research Center for Respiratory Disease, Beijing, ChinaInstitute of Respiratory Medicine, Chinses Academy of Medical Sciences, Beijing, ChinaDepartment of Respiratory and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaSchool of Public Health, Lanzhou University, Lanzhou, ChinaNational Center for Respiratory Disease, Beijing, ChinaNational Clinical Research Center for Respiratory Disease, Beijing, ChinaInstitute of Respiratory Medicine, Chinses Academy of Medical Sciences, Beijing, ChinaDepartment of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, ChinaDepartment of Clinical Research and Data Management, China-Japan Friendship Hospital, Beijing, ChinaNational Center for Respiratory Disease, Beijing, ChinaNational Clinical Research Center for Respiratory Disease, Beijing, ChinaInstitute of Respiratory Medicine, Chinses Academy of Medical Sciences, Beijing, ChinaObjectiveThe aim of this study was to compare the efficacy and safety for particular regimen and dosage in venous thromboembolism (VTE) patients with renal insufficiency.MethodsEnglish language searches of PubMed, Embase, and Web of Science (inception to May 2021). RCTs evaluating anticoagulants for VTE treatment at acute phase, extension phase, and VTE prophylaxis in patients with renal insufficiency and reporting efficacy (death, recurrence, or occurrence of VTE) and safety (bleeding) outcomes were selected. The methodological quality of each study included was assessed at the outcome level using the risk-of-bias assessment tool developed by the Cochrane Bias Methods Group.ResultsTwenty-one trials that involved 76,574 participants and 8,972 (11.7%) patients with renal insufficiency were enrolled, including 10 trials on VTE treatment in acute phase (3–12 months), four trials on VTE treatment in extension phase (6–36 months), and seven trials for VTE prophylaxis. For acute VTE treatment, compared with dabigatran etexilate, apixaban (RR 5.90, 95%CI 1.00–34.60) and rivaroxaban (RR 6.18, 95%CI 1.17–32.75) were significantly associated with increased risk of death or recurrence. For extension treatment of VTE, aspirin had the highest probability of the most effective and safest treatment, followed by apixaban. For VTE prophylaxis, compared with enoxaparin, desirudin was associated with lower risk of VTE occurrence (RR 0.56, 95% CI 0.34–0.91), but had higher risk of bleeding than dabigatran etexilate.ConclusionThe network meta-analysis informs the optimal choice of anticoagulants and their particular dosage for treatment and prophylaxis of VTE patients comorbid renal insufficiency.Systematic review registrationwww.crd.york.ac.uk/prospero/, identifier: CRD42021254086.https://www.frontiersin.org/articles/10.3389/fmed.2022.979911/fullanticoagulant agentsefficacy and safetyvenous thromboembolismrenal insufficiencynetwork meta-analysis |
| spellingShingle | Guohui Fan Guohui Fan Guohui Fan Guohui Fan Dingyi Wang Dingyi Wang Dingyi Wang Dingyi Wang Meng Zhang Xufei Luo Zhenguo Zhai Zhenguo Zhai Zhenguo Zhai Zhenguo Zhai Sinan Wu Sinan Wu Sinan Wu Sinan Wu Anticoagulant for treatment and prophylaxis of venous thromboembolism patients with renal dysfunction: A systematic review and network meta-analysis Frontiers in Medicine anticoagulant agents efficacy and safety venous thromboembolism renal insufficiency network meta-analysis |
| title | Anticoagulant for treatment and prophylaxis of venous thromboembolism patients with renal dysfunction: A systematic review and network meta-analysis |
| title_full | Anticoagulant for treatment and prophylaxis of venous thromboembolism patients with renal dysfunction: A systematic review and network meta-analysis |
| title_fullStr | Anticoagulant for treatment and prophylaxis of venous thromboembolism patients with renal dysfunction: A systematic review and network meta-analysis |
| title_full_unstemmed | Anticoagulant for treatment and prophylaxis of venous thromboembolism patients with renal dysfunction: A systematic review and network meta-analysis |
| title_short | Anticoagulant for treatment and prophylaxis of venous thromboembolism patients with renal dysfunction: A systematic review and network meta-analysis |
| title_sort | anticoagulant for treatment and prophylaxis of venous thromboembolism patients with renal dysfunction a systematic review and network meta analysis |
| topic | anticoagulant agents efficacy and safety venous thromboembolism renal insufficiency network meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.979911/full |
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