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Non-vitamin K oral anticoagulants in patients with pulmonary embolism: a systematic review and meta-analysis of the literature

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Abstract

Limited information exists on the safety and efficacy of non-vitamin K oral anticoagulants (NOACs) in patients with pulmonary embolism (PE). The aim of this study is to evaluate the difference in the safety and efficacy of the NOACs in comparison to the standard treatment in patients presenting with deep vein thrombosis (DVT) and with PE using data from randomized controlled trials. MEDLINE and EMBASE databases were searched. Differences in the efficacy (recurrent VTE or death-related VTE) and in the safety (major bleeding) outcome were expressed as risk ratio (RR) with 95 % confidence intervals (95 % CI). Heterogeneity among the studies was assessed. Six studies (27,023 patients) were included. NOACs appeared to have a similar efficacy and safety compared to VKAs in patients presenting with PE and with DVT with a non-significant heterogeneity between the groups (efficacy: RR 0.90, 95 % CI 0.72, 1.13 in PE patients and 0.93, 95 % CI 0.75, 1.16 in DVT patients; \(\chi^{2}\) 0.04, p = 0.84; safety: RR 0.49, 95 % CI 0.26, 0.95 in PE patients and 0.74 95 % CI 0.51, 1.06 in DVT; \(\chi^{2}\) 1.10, p = 0.29). Our results suggest that the efficacy and safety of the NOACs compared to VKAs is similar between patients with PE and DVT.

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Acknowledgments

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The Authors declare that they have no conflict of interest.

Statement of human and animal rights

The Authors hereby declare that the research involving human participants has been carried out in accordance with the ethical standards of the institutional and national research committee and have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendment or comparable ethical standards.

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Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy

    Francesco Dentali, Alessandro Squizzato & Walter Ageno

  2. Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Via C Parea 4, 20138, Milan, Italy

    Matteo Nicola Dario Di Minno

  3. Department of Clinical Medicine, Hospital of Tradate, Tradate, Italy

    Monica Gianni

  4. Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy

    Pasquale Ambrosino

Authors
  1. Francesco Dentali
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  2. Matteo Nicola Dario Di Minno
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  3. Monica Gianni
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  4. Pasquale Ambrosino
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  5. Alessandro Squizzato
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  6. Walter Ageno
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Correspondence to Matteo Nicola Dario Di Minno.

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Dentali, F., Di Minno, M.N.D., Gianni, M. et al. Non-vitamin K oral anticoagulants in patients with pulmonary embolism: a systematic review and meta-analysis of the literature. Intern Emerg Med 10, 507–514 (2015). https://doi.org/10.1007/s11739-015-1249-x

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  • DOI: https://doi.org/10.1007/s11739-015-1249-x

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