Oral direct thrombin inhibitors or oral factor Xa inhibitors for the treatment of pulmonary embolism

There are no differences in efficacy between direct oral anticoagulants (DOACs) and standard anticoagulation for the long-term treatment of pulmonary embolism.

Summary

A Cochrane review included 5 studies with a total of 7 897 subjects. Two studies tested oral direct thrombin inhibitors (DTIs) (dabigatran) and 3 studies tested oral factor Xa inhibitors (1 rivaroxaban, 1 edoxaban and 1 apixaban). Comparison was warfarin in 4 studies and warfarin or acenocoumarol in 1 study. Study duration varied from 6 to 12 months. None of the studies measured quality of life.

There was no difference in the effectiveness of oral DTIs and standard anticoagulation in preventing recurrent pulmonary embolism, recurrent venous thromboembolism, deep vein thrombosis (DVT) and major bleeding (table ).

For oral factor Xa inhibitors, there was significant heterogeneity for recurrent pulmonary embolism. The oral factor Xa inhibitors were no more or less effective in the prevention of recurrent venous thromboembolism, DVT, all-cause mortality or major bleeding (table ).

Clinical comments

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Ədəbiyyat

1. Robertson L, Kesteven P, McCaslin JE. Oral direct thrombin inhibitors or oral factor Xa inhibitors for the treatment of pulmonary embolism. Cochrane Database Syst Rev 2015;(12):CD010957.