mechanism | treatment | Demonstrated benefit and harm | k | | | |
---|
antithrombotics | aspirin | versus discontinuation No demonstrated result for efficacy | 2 trials | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
WARFASA, 2012 | aspirin vs discontinuation | DVT only 0.55 [0.31; 0.98] recurrence of venous thromboembolism 0.63 [0.41; 0.97] | | major vascular events 1.54 [0.51; 4.62] death 1.15 [0.36; 3.72] major bleeding 0.96 [0.06; 15.26] fatal PE 0.96 [0.06; 15.26] PE 0.76 [0.35; 1.62] major and Clinically relevant nonmajor bleeding 0.96 [0.24; 3.79] | ASPIRE, 2012 | aspirin vs discontinuation | major vascular events 0.70 [0.52; 0.95] net clinical benefit 0.72 [0.55; 0.94] | | death 0.89 [0.46; 1.72] major bleeding 1.75 [0.74; 4.13] fatal PE 1.00 [0.06; 15.93] PE 0.60 [0.34; 1.06] DVT only 0.91 [0.60; 1.37] major and Clinically relevant nonmajor bleeding 1.75 [0.74; 4.13] recurrence of venous thromboembolism 0.78 [0.57; 1.07] |
Trial | Treatments | Patients | Method |
---|
WARFASA, 2012 | aspirin, 100 mg daily for 2 years (n=205) vs. placebo (n=197) | patients with first-ever unprovoked venous thromboembolism who had completed 6 to 18 months of oral anticoagulant treatment | double-blind Parallel groups Sample size: 205/197 Primary endpoint: recurrence of venous thromboembolism FU duration: 24.6 mo (median) | ASPIRE, 2012 | aspirin, at a
dose of 100 mg daily up to 4 years (n=411) vs. (n=411) | patients who had completed initial anticoagulant therapy
after a first episode of unprovoked venous thromboembolism | Sample size: 411/411 Primary endpoint: FU duration: 37.2 montsh (median) |
|
antithrombotics | Bemiparin | versus oral anticoagulant No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Kakkar, 2003 | Bemiparin vs warfarin | | | VTE during active anticoagulant treatment 0.78 [0.19; 3.19] |
Trial | Treatments | Patients | Method |
---|
Kakkar, 2003 | LMWH, 115 IU/kg qd followed by Bemiparin 3,500 IU qd (n=221) vs. A: UFH, 30/40,000IU qd; B: LMWH, 115 IU/kg qd followed by Warfarin target INR 2-3 (n=103) | patients with objective diagnosis of DVT by Venography/compression ultrasonography | open Sample size: 221/103 Primary endpoint: none defined FU duration: 3 mo |
|
antithrombotics | dalteparin | versus anticoagulant No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
CLOT (Lee), 2003 | extended dalteparin vs standard treatment | Recurrent DVT/DVTextension (total) 0.51 [0.33; 0.79] | | All-cause mortality 0.96 [0.79; 1.15] deaths at 6 months 0.96 [0.79; 1.15] Major hemorrhage 1.57 [0.77; 3.18] |
Trial | Treatments | Patients | Method |
---|
CLOT (Lee), 2003 | Dalteparin 200 IU/kg daily for 1 month followed by 150 IU/kg daily for 5 months (n=-9) vs. Dalteparin 200 IU/kg
daily for 5-7 days followed by wafarin or acecumarol (target INR 2-3) for 6 months (n=-9) | patients with active cancer and with DVT or pulmonary embolism or both, and ECOG 1 or 2 | outcome assessment blinded Parallel groups Sample size: -9/-9 Primary endpoint: FU duration: 6 months |
|
antithrombotics | dalteparin | versus oral anticoagulant No demonstrated result for efficacy | 2 trials | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Das, 1996 | Dalteparin vs warfarin | | | VTE during active anticoagulant treatment 2.75 [0.56; 13.55] | Lee, 2003 | Dalteparin vs warfarin | VTE during active anticoagulant treatment 0.51 [0.33; 0.79] | | |
Trial | Treatments | Patients | Method |
---|
Das, 1996 | UFH followed by Dalteparin 5,000 IU qd (n=50) vs. UFH followed by Warfarin target INR 2-3 (n=55) | patients with objective diagnosis of DVT by Venography | open Sample size: 50/55 Primary endpoint: recurrent venous thromboembolism FU duration: 3 mo | Lee, 2003 | LMWH, 200 IU/kg qd followed by Dalteparin 150 IU/kg qd (n=336) vs. LMWH, 200 IU/kg qd followed by Warfarin target INR 2-3 (n=336) | patients with cancer and objective diagnosis of DVT by Venography/compression ultrasonography | open Sample size: 336/336 Primary endpoint: recurrent thrombosis FU duration: 6 mo |
|
antithrombotics | dalteparin | versus No demonstrated result for efficacy | 4 trials | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Bratt et al , 1985 | Dalteparin vs unfractionated heparin | | | all cause death NaN [NaN; NaN] Recurrent thromboembolic event NaN [NaN; NaN] Thrombus extension 0.00 [0.00; NaN] Short term haemorrhage ∞ [NaN; ∞] | Holm et al , 1986 | Dalteparin vs unfractionated heparin | | | all cause death NaN [NaN; NaN] Recurrent thromboembolic event ∞ [NaN; ∞] Thrombus extension 0.47 [0.04; 4.85] Short term haemorrhage NaN [NaN; NaN] | Bratt et al, 1990 | Dalteparin vs unfractionated heparin | | | all cause death 1.83 [0.72; 4.64] Recurrent thromboembolic event 0.67 [0.20; 2.24] Thrombus extension 0.67 [0.12; 3.85] Short term haemorrhage 0.00 [0.00; NaN] | Lindmarker et al , 1993 | Dalteparin vs unfractionated heparin | | | all cause death 0.68 [0.12; 3.98] Recurrent thromboembolic event 2.04 [0.52; 7.93] Thrombus extension 0.73 [0.24; 2.22] Short term haemorrhage NaN [NaN; NaN] |
Trial | Treatments | Patients | Method |
---|
Bratt et al , 1985 | Dalteparin Intravenousv (ajusted) for >=5 Days, 120 U/kg BID (n=25) vs. unfractionated heparin intravenous APPTx1.7-3.5 (n=29) | | Sample size: 25/29 Primary endpoint: FU duration: 23 Months (mean) | Holm et al , 1986 | Dalteparin Subcutaneous twice daily ajusted for 7 Days, 57-107 U/kg BID (n=29) vs. unfractionated heparin subcutaneous twice daily 16000-30000 U (n=27) | | Sample size: 29/27 Primary endpoint: FU duration: Hospital Stay | Bratt et al, 1990 | Dalteparin Subcutaneous twice daily ajusted for >= 5 Days, 120 U/kg BID (n=60) vs. unfractionated heparin intravenous APPTx2-4 (n=60) | | Sample size: 60/60 Primary endpoint: FU duration: Hospital stay | Lindmarker et al , 1993 | Dalteparin Subcutaneous once daily for >= 5 Days, 200 U/kg BID (n=101) vs. unfractionated heparin intravenous APPTx1.5-3 (n=103) | | Sample size: 101/103 Primary endpoint: FU duration: 6 Months |
|
antithrombotics | dalteparin | versus twice daily LMWH No demonstrated result for efficacy | 2 trials | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Holmström, 1992 | once daily dalteparin vs twice daily dalteparin | | | Improvement of thrombus size 1.07 [0.72; 1.59] Haemorraghic events 0.00 [0.00; NaN] | Partsch, 1996 | once daily dalteparin vs twice daily dalteparin | | | Mortality 2.53 [0.27; 23.70] Haemorraghic events ∞ [NaN; ∞] |
Trial | Treatments | Patients | Method |
---|
Holmström, 1992 | once daily dalteparin 200 U (anti-FXa)/kg for at least 5 days (n=50) vs. twice daily dalteparin 100
U (anti-FXa)/kg for at least 5 days (n=51) | Patients with a first occurence of DVT in the lower limb, confirmed with phlebographytio | open Parallel groups Sample size: 50/51 Primary endpoint: FU duration: | Partsch, 1996 | Fragmin administered 200 IU/kg once daily for at least 7 days (n=76) vs. Fragmin 100 IU/kg twice daily for at least 7 days (n=64) | patients presented with DVT extending into the iliofemoral segment diagnosed by duplex ultrasonographyA | NA Parallel groups Sample size: 76/64 Primary endpoint: FU duration: |
|
antithrombotics | edoxaban | versus No demonstrated result for efficacy edoxaban inferior to dalteparin in terms of Major hemorrhage in Hokusai-VTE Cancer, 2017 (patients with cancer patients) | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Hokusai-VTE Cancer, 2017 | edoxaban vs dalteparin | | Major hemorrhage 1.77 [1.03; 3.04] | recurrent
venous thromboembolism or major bleeding 0.97 [0.70; 1.35] All-cause mortality 1.12 [0.92; 1.37] Recurrent DVT/DVT extension (symptomatic) 0.71 [0.48; 1.06] recurrent VTE 0.71 [0.48; 1.06] |
Trial | Treatments | Patients | Method |
---|
Hokusai-VTE Cancer, 2017 | low-molecular-weight heparin for at least 5 days followed by oral edoxaban at a dose of 60 mg once daily. Treatment was given for atleast 6 months and up to 12 months. (n=522) vs. subcutaneous dalteparin at a dose of 200 IU per kilogram of body weight once daily for 1 month followed by dalteparin at a dose of 150 IU per kilogram once daily (n=524) | patients with cancer who had acute symptomatic or incidental venous thromboembolism | open label Sample size: 522/524 Primary endpoint: recurrent venous thromboembolism or major bleeding at12 months FU duration: |
|
antithrombotics | enoxaparin | versus anticoagulant No demonstrated result for efficacy | 3 trials | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Cesarone, 2003 | extended enoxaparin vs standard treatment | | | All-cause mortality 0.67 [0.11; 3.90] Recurrent DVT/DVTextension (total) 0.66 [0.16; 2.74] death at 3 months 0.67 [0.11; 3.90] | Deitcher, 2006 | extended enoxaparin vs standard treatment | | | All-cause mortality 1.01 [0.56; 1.84] deaths at 6 months 1.01 [0.56; 1.84] Major hemorrhage 3.04 [0.38; 24.28] | Meyer, 2002 | extended enoxaparin vs standard treatment | | | All-cause mortality 0.80 [0.51; 1.26] deaths at 6 months 0.80 [0.51; 1.26] Major hemorrhage 0.44 [0.16; 1.19] Recurrent DVT/DVTextension (total) 0.70 [0.12; 4.09] Thrombocytopenia 0.94 [0.52; 1.69] death at 3 months 0.50 [0.23; 1.08] |
Trial | Treatments | Patients | Method |
---|
Cesarone, 2003 | Enoxaparin 100UL/Kg twice daily for 3 months (n=-9) vs. coumadin (target INR 3) for 3 months. (n=-9) | patients with cancer with DVT | NA Parallel groups Sample size: -9/-9 Primary endpoint: Death at 3 months FU duration: 3 months | Deitcher, 2006 | Enoxaparin 1mg/kg twice daily for 5 days followed by 1-1.5mg/kg daily for 175 days (n=-9) vs. Enoxaparin 1mg/kg
twice daily for 5 days followed by warfarin (target INR 2-3) for a total of 180 days (n=-9) | patients with cancer with DVT and/or PE | none Parallel groups Sample size: -9/-9 Primary endpoint: FU duration: 12 months | Meyer, 2002 | Enoxaparin 1.5 mg/kg daily for 3 monthsmag (n=-9) vs. Enoxaparin 1.5 mg/kg daily for 4 days followed by warfarin (target
INR 2-3) for 3 months (n=-9) | patients with cancer (solid or hematological; active or in remission but on treatment); with pulmonary embolism and/or DVT and a minimum life expectancy of 3 months | outcome assessment blinded Parallel groups Sample size: -9/-9 Primary endpoint: FU duration: 3 months |
|
antithrombotics | enoxaparin | versus oral anticoagulant No demonstrated result for efficacy Enoxaparin inferior to coumarin in terms of VTE during active anticoagulant treatment in González-Fajardo, 2008 | 6 trials | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Pini, 1994 | Enoxaparin vs warfarin | | | VTE during follow-up after active anticoagulant treatment 2.56 [0.83; 7.85] VTE during active anticoagulant treatment 1.52 [0.44; 5.20] | Gonzalez-Fajardo, 1999 | Enoxaparin vs warfarin | VTE during active anticoagulant treatment 0.42 [0.19; 0.90] | | | Veiga, 2000 | Enoxaparin vs acenocoumarol | | | VTE during follow-up after active anticoagulant treatment 1.25 [0.41; 3.82] VTE during active anticoagulant treatment 2.00 [0.19; 21.36] | Meyer, 2002 | Enoxaparin vs warfarin | | | VTE during follow-up after active anticoagulant treatment ∞ [NaN; ∞] | Deitcher, 2003 | Enoxaparin vs warfarin | | | VTE during active anticoagulant treatment 0.59 [0.09; 3.96] | González-Fajardo, 2008 | Enoxaparin vs coumarin | | VTE during active anticoagulant treatment 1.97 [1.06; 3.66] | |
Trial | Treatments | Patients | Method |
---|
Pini, 1994 | UFH, APTT 1.3–1.9 followed by Enoxaparin 4,000 IU qd (n=93) vs. UFH, APTT 1.3–1.9 followed by Warfarin target INR 2-3.5 (n=94) | patients with objective diagnosis of DVT by Venography (diagnosed by strain-gauge plethysmography plus D-dimer latex assay and confirmed by venography) | open Sample size: 93/94 Primary endpoint: none defined FU duration: 9 mo | Gonzalez-Fajardo, 1999 | LMWH, 4,000 IU bid followed by Enoxaparin 4,000 IU qd (n=93) vs. UFH followed by Warfarin target INR 2-3 (n=92) | patients with objective diagnosis of DVT by Venography | open Parallel groups Sample size: 93/92 Primary endpoint: none defined FU duration: 9 mo | Veiga, 2000 | UFH, APTT 1.5–2.0d followed by Enoxaparin 4,000 IU qd (n=50) vs. UFH, APTT 1.5–2.0d followed by Acenocoumarol target INR 2-3 (n=50) | patients with objective diagnosis of DVT by Venography | open Sample size: 50/50 Primary endpoint: none defined FU duration: 6-9 mo | Meyer, 2002 | LMWH, 1.5 mg/kg qd followed by Enoxaparin 1.5 mg/Kg qd (n=71) vs. LMWH, 1.5 mg/kg qd followed by Warfarin target INR 2-3 (n=58) | patients with cancer and objective diagnosis of DVT by Venography/compression ultrasonography | open Sample size: 71/58 Primary endpoint: major bleeding or recurrent venous thromboembolism FU duration: 3 mo | Deitcher, 2003 | LMWH: 1a, 1 mg/kg q12h; 1b, 1 mg/kg qd12h followed by Enoxaparin 1a: 1 mg/kg qd; 1b: 1.5 mg/kg qd (n=51) vs. LMWH, 1 mg/kg q12h followed by Warfarin target INR 2-3 (n=30) | patients with objective diagnosis of DVT | open Sample size: 51/30 Primary endpoint: FU duration: 6 mo | González-Fajardo, 2008 | long-term anticoagulant treatment with enoxaparin during at least 3 months (n=85) vs. long-term anticoagulant treatment with coumarin during at least 3 months (n=80) | patients with symptomatic, unilateral, first-episode DVT | open, blind assessment Parallel groups Sample size: 85/80 Primary endpoint: incidence of post-thrombotic syndrome FU duration: 1y, 5y |
|
antithrombotics | enoxaparin | versus No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Simonneau et al , 1993 | Enoxaparin vs unfractionated heparin | | | all cause death 1.50 [0.26; 8.69] Recurrent thromboembolic event 0.00 [0.00; NaN] Thrombus extension 0.14 [0.02; 1.13] Short term haemorrhage NaN [NaN; NaN] |
Trial | Treatments | Patients | Method |
---|
Simonneau et al , 1993 | Enoxaparin Subcutaneous twice daily for 0 Days, 100 U/kg BID (n=67) vs. unfractionated heparin intravenous APPTx1.5-2.5 (n=67) | | Sample size: 67/67 Primary endpoint: FU duration: 3 Months |
|
antithrombotics | enoxaparin | versus twice daily LMWH No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Merli, 2001 | once daily enoxaparin vs twice daily enoxaparin | | | Mortality 1.65 [0.65; 4.19] Haemorraghic events 1.31 [0.35; 4.83] Recurrent thromboembolic events 1.51 [0.66; 3.49] |
Trial | Treatments | Patients | Method |
---|
Merli, 2001 | enoxaparin 1.5 mg/kg body weight
once daily (n=298) vs. S.c. enoxaparin at fixed dosages of 1.0 mg/kg of body weight twice daily (n=312) | patients with a symptomatic lower-extremity DVT confirmed by venography or ultrasonography (including patients with confirmed PE) | double blind Parallel groups Sample size: 298/312 Primary endpoint: FU duration: |
|
antithrombotics | enoxaparin | versus UFH No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Merli (once daily vs UFH), 2001 | once daily enoxaparin vs UFH | | | Mortality 1.19 [0.50; 2.83] Haemorraghic events 1.15 [0.77; 1.70] Recurrent thromboembolic events 1.05 [0.49; 2.27] |
Trial | Treatments | Patients | Method |
---|
Merli (once daily vs UFH), 2001 | Initial therapy with enoxaparin 1.5 mg/kg body weight
once daily
(n=298) vs. Initial therapy with dose-adjusted intravenous
unfractionated heparin (n=290)
| patients with a symptomatic lower-extremity DVT confirmed by venography or ultrasonography (including patients with confirmed PE)
| partialy blinded Parallel groups Sample size: 298/290 Primary endpoint: occurrence of symptomatic recurrent venous thromboembolism FU duration: 3 months
|
|
antithrombotics | fondaparinux | versus No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
MATISSE, 2004 | fondaparinux vs enoxaparin | | | Recurrent DVT/DVT extension (symptomatic) 0.96 [0.64; 1.45] All-cause mortality 1.25 [0.80; 1.97] Major hemorrhage 1.09 [0.64; 1.84] Non-fatal PE 1.68 [0.83; 3.42] Fatal PE 1.01 [0.29; 3.47] |
Trial | Treatments | Patients | Method |
---|
MATISSE, 2004 | fondaparinux 7.5 mg subcutaneously once daily for at least 5 days and until vitamin K antagonists induced an INR greater than 2.0. (n=1098) vs. enoxaparin, 1 mg/kg of body weight, subcutaneously twice daily for at least 5 days and until vitamin K antagonists induced an INR greater than 2.0. (n=1107) | patients with acute symptomatic deep venous thrombosis | double blind Parallel groups Sample size: 1098/1107 Primary endpoint: symptomatic recurrent venous thromboembolic FU duration: 3 months |
|
antithrombotics | heparin | versus placebo or control No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Ott importé, 1998 | heparin+warfarin vs placebo | | | Fatal PE 1.09 [0.08; 15.42] |
Trial | Treatments | Patients | Method |
---|
Ott importé, 1998 | anticoagulants (s.c. heparin followed by oral warfarin) (duration NA) (n=11) vs. s.c. saline followed by oral placebo tablets (n=12) | | double blind Sample size: 11/12 Primary endpoint: FU duration: |
|
antithrombotics | heparin | versus No demonstrated result for efficacy subcutaneous heparin inferior to intravenous heparin in terms of extension or recurrence of VTE in Hull, 1986 | 9 trials | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Nielsen importé, 1994 | heparin+phenprocoumon vs phenylbutazone | | | | Krahenbuhl, 1979 | subcutaneous heparin vs intravenous heparin | | | | Bentley, 1980 | subcutaneous heparin vs intravenous heparin | extension or recurrence of VTE 0.10 [0.01; 0.75] | | major hemorrhage 0.25 [0.03; 2.16] | Andersson, 1982 | subcutaneous heparin vs intravenous heparin | | | | Hull, 1986 | subcutaneous heparin vs intravenous heparin | | extension or recurrence of VTE 3.73 [1.10; 12.68] | major hemorrhage 1.02 [0.15; 6.98] | Doyle, 1987 | subcutaneous heparin vs intravenous heparin | | | major hemorrhage 2.04 [0.39; 10.65] extension or recurrence of VTE 1.02 [0.31; 3.31] | Walker, 1987 | subcutaneous heparin vs intravenous heparin | extension or recurrence of VTE 0.15 [0.04; 0.65] | | major hemorrhage 1.00 [0.15; 6.82] | Lopaciuk | subcutaneous heparin vs intravenous heparin | | | major hemorrhage 1.92 [0.18; 20.43] extension or recurrence of VTE 0.27 [0.06; 1.25] | Pini, 1990 | subcutaneous heparin vs intravenous heparin | | | major hemorrhage 0.54 [0.18; 1.56] extension or recurrence of VTE 1.93 [0.36; 10.35] |
Trial | Treatments | Patients | Method |
---|
Nielsen importé, 1994 | heparin and phenprocoumon for 3 months (n=48) vs. phenylbutazone (n=42) | | open Sample size: 48/42 Primary endpoint: FU duration: | Krahenbuhl, 1979 | subcutaneous sodic heparin 30 000 U daily (mean) (n=23) vs. intravenous sodic heparin 30 000 U daily (mean) (n=25) | | Sample size: 23/25 Primary endpoint: FU duration: | Bentley, 1980 | subcutaneous calcic heparin 37 000 U daily (mean) (n=50) vs. intravenous sodic heparin 36 800 U daily (mean) (n=50) | | Sample size: 50/50 Primary endpoint: FU duration: | Andersson, 1982 | subcutaneous sodic heparin 36 800 U daily (mean) (n=72) vs. intravenous sodic heparin 33 250 U daily (mean) (n=69) | | Sample size: 72/69 Primary endpoint: FU duration: | Hull, 1986 | subcutaneous sodic heparin 32 300 U daily (mean) (n=57) vs. intravenous sodic heparin 29 700 U daily (mean) (n=58) | | Sample size: 57/58 Primary endpoint: FU duration: | Doyle, 1987 | subcutaneous calcic heparin 29 200 U daily (mean) (n=51) vs. intravenous calcic heparin 29 600 U daily (mean) (n=52) | | Sample size: 51/52 Primary endpoint: FU duration: | Walker, 1987 | subcutaneous calcic heparin 29 375 U daily (mean) (n=50) vs. intravenous calcic heparin 24 384 U daily (mean) (n=50) | | Sample size: 50/50 Primary endpoint: FU duration: | Lopaciuk | subcutaneous sodic heparin 34 400 U daily (mean) (n=48) vs. intravenous sodic heparin 37 000 U daily (mean) (n=46) | | Sample size: 48/46 Primary endpoint: FU duration: | Pini, 1990 | subcutaneous calcic heparin 33 800 U daily (mean) (n=138) vs. intravenous sodic heparin 31 700 U daily (mean) (n=133) | | Sample size: 138/133 Primary endpoint: FU duration: |
|
antithrombotics | idraparinux | versus anticoagulant No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Van Gogh (subgroup), 2011 | idraparinux vs standard treatment | | | all bleeding 0.89 [0.50; 1.59] deaths at 6 months 0.99 [0.66; 1.48] Recurrent DVT/DVTextension (total) 0.38 [0.14; 1.06] |
Trial | Treatments | Patients | Method |
---|
Van Gogh (subgroup), 2011 | once-weekly subcutaneous injection of idraparinux (2.5 mg) for 6 months (n=220) vs. standard treatment for three months (8%) or six months (92%) (n=201) | non-active and active cancer patients with deep venous thrombosis and without pulmonary embolism, included in the Van Gogh DVT clinical trial | Parallel groups Sample size: 220/201 Primary endpoint: FU duration: 6 months |
|
antithrombotics | logiparin | versus twice daily LMWH No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Siegbahn, 1989 | once daily logiparin vs twice daily logiparin | | | Improvement of thrombus size 2.00 [0.68; 5.85] Mortality NaN [NaN; NaN] Haemorraghic events NaN [NaN; NaN] Recurrent thromboembolic events NaN [NaN; NaN] |
Trial | Treatments | Patients | Method |
---|
Siegbahn, 1989 | Once daily logiparin 150 XaI U/kgp, imag (n=10) vs. twice daily logiparin 75 XaI U/kg (n=10) | patients with a venographically confirmed episode of DVT | single blind Parallel groups Sample size: 10/10 Primary endpoint: FU duration: |
|
antithrombotics | nadroparin | versus anticoagulant No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Lopez Beret, 2001 | extended nadroparin vs standard treatment | | | All-cause mortality 1.24 [0.52; 2.94] |
Trial | Treatments | Patients | Method |
---|
Lopez Beret, 2001 | Nadroparin 1.025 antiXa IU/10Kg
twice daily after aadroparin 1.025AXa IU/10Kg twice daily for 3 days. After 3 months, nadroparin was switched to once daily (n=-9) vs. acenocoumarol (target INR 2-3) for 3-6 months after nadroparin 1.025AXa IU/10Kg twice daily for 3 days (n=-9) | patients with known malignancy treated for symptomatic DVT of the lower limb | outcome assessment blinded Parallel groups Sample size: -9/-9 Primary endpoint: Death at 12 months FU duration: 12 months |
|
antithrombotics | nadroparin | versus oral anticoagulant No demonstrated result for efficacy | 2 trials | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Lopaciuk, 1999 | Nadroparin vs acenocoumarol | | | VTE during follow-up after active anticoagulant treatment 2.53 [0.50; 12.71] VTE during active anticoagulant treatment 0.43 [0.11; 1.61] | Lopez-Beret, 2001 | Nadroparin vs acenocoumarol | | | VTE during follow-up after active anticoagulant treatment 0.50 [0.09; 2.65] VTE during active anticoagulant treatment 2.85 [0.80; 10.14] |
Trial | Treatments | Patients | Method |
---|
Lopaciuk, 1999 | LMWH, 85 UI/kg bid followed by Nadroparin 85 IU/kg qd (n=101) vs. LMWH, 85 UI/kg bid followed by Acenocoumarol target INR 2-3 (n=101) | patients with objective diagnosis of DVT by Venography | open Sample size: 101/101 Primary endpoint: none defined FU duration: 9 mo | Lopez-Beret, 2001 | LMWH, 1,025 IU/10 kg bid followed by Nadroparin 1,025 IU/10 kg bid (n=81) vs. LMWH, 1,025 IU/10 kg bid followed by Acenocoumarol target INR 2-3 (n=77) | patients with objective diagnosis of DVT by compression ultrasonography | open Sample size: 81/77 Primary endpoint: none defined FU duration: 6-9 mo |
|
antithrombotics | nadroparin | versus No demonstrated result for efficacy | 3 trials | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Collaborative European Multicentre, 1991 | Nadroparin vs unfractionated heparin | | | all cause death 1.89 [0.18; 20.31] Recurrent thromboembolic event 2.83 [0.30; 26.52] Thrombus extension 0.47 [0.09; 2.49] Short term haemorrhage 1.89 [0.36; 9.95] | Prandoni et al , 1992 | Nadroparin vs unfractionated heparin | Thrombus extension 0.36 [0.13; 0.95] | | all cause death 0.50 [0.20; 1.27] Recurrent thromboembolic event 0.50 [0.20; 1.27] Short term haemorrhage 0.33 [0.04; 3.14] | Lopaciuk et al , 1992 | Nadroparin vs unfractionated heparin | | | all cause death 0.00 [0.00; NaN] Recurrent thromboembolic event 0.00 [0.00; NaN] Thrombus extension 0.84 [0.39; 1.83] Short term haemorrhage 0.00 [0.00; NaN] |
Trial | Treatments | Patients | Method |
---|
Collaborative European Multicentre, 1991 | Nadroparin Subcutaneous twice daily for 10 Days, 90 U/kg BID (n=70) vs. unfractionated heparin intravenous APPTx1.5-2 (n=66) | | Sample size: 70/66 Primary endpoint: FU duration: 12 Weeks | Prandoni et al , 1992 | Nadroparin Subcutaneous twice daily for >=0 Days, 90 U/kg BID (n=85) vs. unfractionated heparin intravenous APPTx1.5-2 (n=85) | | Sample size: 85/85 Primary endpoint: FU duration: 6 Months | Lopaciuk et al , 1992 | Nadroparin Subcutaneous twice daily for 10 Days, 92 U/kg BID (n=74) vs. unfractionated heparin subcutaneous twice daily APPTx1.5-2.5 (n=75) | | Sample size: 74/75 Primary endpoint: FU duration: 3 Months |
|
antithrombotics | nadroparin | versus twice daily LMWH No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Charbonnier, 1998 | once daily nadroparin vs twice daily nadroparin | | | Mortality 0.73 [0.32; 1.69] Haemorraghic events 0.62 [0.29; 1.34] Recurrent thromboembolic events 0.57 [0.30; 1.11] |
Trial | Treatments | Patients | Method |
---|
Charbonnier, 1998 | Once daily nadroparin 20,500 (AXa IU/ml)continued for at least 5 days (n=316) vs. twice daily
nadroparin 10,250 (AXa IU/ml)continued for at least 5 days (n=335) | patients with acute symptomatic proximal DVT in popliteal vein or above
documented by venography | double blind Parallel groups Sample size: 316/335 Primary endpoint: FU duration: |
|
antithrombotics | rivaroxaban | versus No demonstrated result for efficacy rivaroxaban inferior to dalteparin in terms of all bleeding in SELECT D, 2018 (patients with cancer patients) | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
SELECT D, 2018 | rivaroxaban vs dalteparin | recurrent VTE 0.43 [0.19; 0.98] | all bleeding 3.76 [1.63; 8.68] | Major hemorrhage 1.83 [0.68; 4.94] |
Trial | Treatments | Patients | Method |
---|
SELECT D, 2018 | rivaroxaban (15 mg twice daily for 3 weeks, then 20 mg once daily for a total of 6 months) (n=203) vs. dalteparin (200 IU/kg daily during month 1, then 150 IU/kg daily for months 2-6) (n=203) | patients with active cancer who had symptomatic pulmonary embolism (PE), incidental PE, or symptomatic lowerextremity proximal deep vein thrombosis (DVT) | open-design Sample size: 203/203 Primary endpoint: FU duration: pilot trial |
|
antithrombotics | tinzaparin | versus anticoagulant No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Hull, 2006 | extended tinzaparin vs standard treatment | | | All-cause mortality 1.05 [0.60; 1.85] Major hemorrhage 1.00 [0.36; 2.75] Recurrent DVT/DVTextension (total) 0.44 [0.19; 1.02] Thrombocytopenia 1.50 [0.44; 5.15] death at 3 months 1.05 [0.60; 1.85] |
Trial | Treatments | Patients | Method |
---|
Hull, 2006 | Tinzaparin 175 antiXa/kg SQ daily for 12 weeks (n=-9) vs. UFH for 5 days followed by vitamin K antagonist (target
INR 2-3) for 12 weeks (n=-9) | patients with cancer (solid or hematological) with proximal DVT with or without PE and with a minimum life expectancy of 3 months imag | outcome assessment blinded Parallel groups Sample size: -9/-9 Primary endpoint: FU duration: 3 months |
|
antithrombotics | tinzaparin | versus oral anticoagulant No demonstrated result for efficacy | 2 trials | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Hull, 2002 | Tinzaparin vs warfarin | | | VTE during follow-up after active anticoagulant treatment 1.00 [0.50; 2.01] VTE during active anticoagulant treatment 0.76 [0.40; 1.43] | Romera, 2009 | Tinzaparin vs acenocoumarol | DVT (recurrent) 0.21 [0.05; 0.92] | | bleeding 0.34 [0.04; 3.24] VTE at the end of trial 0.47 [0.19; 1.20] VTE during follow-up after active anticoagulant treatment 0.17 [0.02; 1.40] VTE during active anticoagulant treatment 0.73 [0.24; 2.24] PE 1.37 [0.31; 5.98] |
Trial | Treatments | Patients | Method |
---|
Hull, 2002 | LMWH, 175 IU/kg qd followed by Tinzaparin 175 IU/kg qd (n=369) vs. UFH 5 d, followed by UFH therapeutic APTT followed by Warfarin target INR 2-3 (n=368) | patients with objective diagnosis of DVT by Venography/compression ultrasonography | open Sample size: 369/368 Primary endpoint: FU duration: 9 mo | Romera, 2009 | tinzaparin SC 175 IU anti-Xa per kg once daily for 6 months (n=119) vs. acenocoumarol for target INR 2-3 for 6 months after initial LMWH (until INR 2-3) (n=122) | patients with symptomatic proximal DVT of the lowerlimbs confirmed by compression duplex ultrasound scan | open Parallel groups Sample size: 119/122 Primary endpoint: symptomatic recurrent venous thromboembolism FU duration: 12 months |
|
antithrombotics | tinzaparin | versus No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Hull et al , 1992 | Tinzaparin vs unfractionated heparin | Short term haemorrhage 0.09 [0.01; 0.72] | | all cause death 0.49 [0.24; 1.02] Recurrent thromboembolic event 0.41 [0.16; 1.04] |
Trial | Treatments | Patients | Method |
---|
Hull et al , 1992 | Tinzaparin Subcutaneous once daily for >= Days, 175 U/kg BID (n=213) vs. unfractionated heparin intravenous APPTx2-3 (n=219) | | Sample size: 213/219 Primary endpoint: FU duration: 3 Months |
|
antithrombotics | warfarin | versus No demonstrated result for efficacy | 3 trials | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Schulman, 1995 | 6 months vs 1.5 months | Incidence of recurrent VTE (period after cessation of study medication until end of follow-up) 0.05 [0.01; 0.19] Incidence of recurrent VTE 0.52 [0.37; 0.74] | | Mortality 0.75 [0.41; 1.40] Incidence of major bleeding 4.88 [0.57; 41.60] | Pinede, 2001 | 3-6 months vs 1.5-3 months | | | Incidence of recurrent VTE (period after cessation of study medication until end of follow-up) 0.17 [0.02; 1.43] Mortality 1.32 [0.61; 2.87] Incidence of major bleeding 1.73 [0.64; 4.71] Incidence of recurrent VTE 1.17 [0.68; 2.02] | ELAET (Kearon), 2004 | warfarin vs discontinuation | | | Incidence of recurrent VTE (period after cessation of study medication until end of follow-up) 0.52 [0.05; 5.61] Incidence of major bleeding (period after cessation of study medication until end of follow-up) NaN [NaN; NaN] Mortality (period after cessation of study medication until end of follow-up) NaN [NaN; NaN] Mortality ∞ [NaN; ∞] Incidence of major bleeding NaN [NaN; NaN] Incidence of recurrent VTE 0.62 [0.15; 2.52] |
Trial | Treatments | Patients | Method |
---|
Schulman, 1995 | 6 months treatment with warfarin or dicoumarol adjusted for a target INR between 2.0 - 2.85 (n=-9) vs. 1.5 months warfarin or dicoumarol adjusted for a target INR between 2.0 - 2.85 (n=-9) | | open Parallel groups Sample size: -9/-9 Primary endpoint: recurrent VTE, major bleeding, death FU duration: Two years after randomization | Pinede, 2001 | Long course of therapy (6 months for proximal DVT and/or PE; 12 weeks for calf DVT) by fluindione adjusted for INR range of 2.0 to 3.0 (n=-9) vs. Short oral anticoagulant course (3 months for proximal DVT and/or PE; 6 weeks for isolated calf
DVT) by fluindione adjusted for INR range of 2.0 to 3.0 (n=-9) randomization at the end of heparin therapy | | open Parallel groups Sample size: -9/-9 Primary endpoint: Recurrent VTE FU duration: 15 months after randomizationÛ | ELAET (Kearon), 2004 | continuation for 2 additionnal months of warfarin adjusted to achieve
a target INR between 2.0 and 3.0. (n=-9) vs. discontinuation (after 1 months) (n=-9) | | double blind Parallel groups Sample size: -9/-9 Primary endpoint: recurrent VTE FU duration: 11 months (after randomizatio) |
|
antithrombotics | warfarin | versus discontinuation No demonstrated result for efficacy | 6 trials | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Levine, 1995 | warfarin vs discontinuation | Incidence of recurrent VTE (period after cessation of study medication until end of follow-up) 0.11 [0.01; 0.83] | | Incidence of major bleeding (period after cessation of study medication until end of follow-up) ∞ [NaN; ∞] Mortality (period after cessation of study medication until end of follow-up) 0.96 [0.40; 2.33] Mortality 0.96 [0.40; 2.33] Incidence of major bleeding ∞ [NaN; ∞] Incidence of recurrent VTE 0.56 [0.23; 1.37] | LAFIT (Kearon), 1999 | warfarin vs discontinuation | Incidence of recurrent VTE (period after cessation of study medication until end of follow-up) 0.06 [0.01; 0.45] Incidence of recurrent VTE 0.06 [0.01; 0.45] | | Incidence of major bleeding (period after cessation of study medication until end of follow-up) ∞ [NaN; ∞] Mortality (period after cessation of study medication until end of follow-up) 0.35 [0.04; 3.30] Mortality 0.35 [0.04; 3.30] Incidence of major bleeding ∞ [NaN; ∞] | Agnelli, 2001 | warfarin vs discontinuation | | | DVT 0.88 [0.47; 1.66] Incidence of recurrent VTE (period after cessation of study medication until end of follow-up) 0.36 [0.12; 1.11] Incidence of major bleeding (period after cessation of study medication until end of follow-up) 3.97 [0.45; 35.06] Mortality 0.99 [0.36; 2.75] Incidence of major bleeding 1.99 [0.37; 10.65] PE (with or without DVT) 1.65 [0.40; 6.78] Incidence of recurrent VTE 0.99 [0.57; 1.73] | Agnelli, 2003 | warfarin vs discontinuation | | | Incidence of recurrent VTE (period after cessation of study medication until end of follow-up) 0.16 [0.02; 1.34] Mortality 1.67 [0.68; 4.14] Incidence of major bleeding 2.93 [0.31; 27.85] Incidence of recurrent VTE 0.81 [0.42; 1.56] | PREVENT (Ridker), 2003 | warfarin vs discontinuation | Incidence of recurrent VTE 0.38 [0.21; 0.68] | | Mortality 0.50 [0.15; 1.63] Incidence of major bleeding 2.48 [0.49; 12.67] | DURAC (Schulman), 1997 | warfarin vs discontinuation | Incidence of recurrent VTE (period after cessation of study medication until end of follow-up) 0.12 [0.04; 0.40] Incidence of recurrent VTE 0.12 [0.04; 0.40] | | Mortality 0.60 [0.28; 1.26] Incidence of major bleeding 3.19 [0.90; 11.29] |
Trial | Treatments | Patients | Method |
---|
Levine, 1995 | continuation for 2 months of warfarin adjusted INR value of 2.0 to 3.0 (n=-9) vs. Discontinue oral anticoagulant therapy (after 1 months) (n=-9) | Patients with venographically confirmed acute proximal DVT who had received four weeks of warfarin after initial heparin and whose four week IPG was normal | double blind Parallel groups Sample size: -9/-9 Primary endpoint: RecurrentDVT or PE andmajor bleeding FU duration: 11 months after randomization. | LAFIT (Kearon), 1999 | Continuation of the oral anticoagulant therapy up to 24 months,
warfarin was adjusted to achieve
a target INR between 2.0 and 3.0. (n=-9) vs. discontinuation (after 3 months) (n=-9) | patients who had completed 3 months of anticoagulant therapy for a first episode of idiopathic venous thromboembolism | Sample size: -9/-9 Primary endpoint: FU duration: | Agnelli, 2001 | continuation for 9 additional months; warfarin or acenocoumarol adjusted to achieve a target INR between 2.0 and 3.0 (n=-9) vs. discontinuation (after 3 months months) (n=-9) | Patients with a first episode of idiopathic proximal deep venous thrombosis who had completed three months of oral anticoagulant therapy | open Parallel groups Sample size: -9/-9 Primary endpoint: Recurrent VTE FU duration: 33 months | Agnelli, 2003 | continuation for 3 or 9 additionnal months of warfarin or other oral anticoagulant was adjusted to achieve a target INR between 2.0 and 3.0. (n=-9) vs. discontinuation (after 3 months) (n=-9) | patients who had had 3 months of oral anticoagulant therapy without experiencing recurrence or bleeding after a first episode of pulmonary embolism | open Parallel groups Sample size: -9/-9 Primary endpoint: Recurrence of symptomatic confirmed VTE./pj FU duration: 33 months | PREVENT (Ridker), 2003 | extension with low-intensity warfarin (target INR, 1.5 to 2.0) (n=255) vs. placebo (n=253) | Patients with idiopathic venous thromboembolism who had received full-dose anticoagulation therapy for a median of 6.5 months | Parallel groups Sample size: 255/253 Primary endpoint: FU duration: 2.1 years | DURAC (Schulman), 1997 | indefinite warfarin or dicoumarol adjusted for a target INR between 2.0 and 2.85 (n=-9) vs. 6 months warfarin or dicoumarol adjusted for a target INR between 2.0 and 2.85 (n=-9) | | open Parallel groups Sample size: -9/-9 Primary endpoint: recurrent VTE, death, major bleeding FU duration: Four years after randomization |
|
antithrombotics | warfarin | versus LMWH No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Wells (subgroup), 2005 | tinzaparin vs dalteparin | | | All-cause mortality 1.16 [0.58; 2.34] Major hemorrhage 0.46 [0.04; 4.90] Recurrent DVT/DVTextension (total) 2.29 [0.46; 11.31] Thrombocytopenia 0.46 [0.04; 4.90] |
Trial | Treatments | Patients | Method |
---|
Wells (subgroup), 2005 | Tinzaparin 175 IU/kg SQ daily (warfarin started simultaneously and continued for 90 days) (n=-9) vs. dalteparin 200 IU/kg daily for at least 5 days ((warfarin started simultaneously and continued for 90 days) (n=-9) | study subgroup of patients with cancer treated for upper or lower extremity DVT or PE in the outpatient setting | outcome assessment blinded Parallel groups Sample size: -9/-9 Primary endpoint: FU duration: 3 months |
|
antithrombotics | ximelagatran | versus discontinuation No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
THRIVE III, 2003 | ximelagatran vs discontinuation | Recurrent DVT/DVT extension (symptomatic) 0.17 [0.09; 0.31] VTA 0.24 [0.15; 0.40] | | All-cause mortality 0.86 [0.29; 2.53] Major hemorrhage 1.20 [0.37; 3.90] any bleedings 1.21 [0.96; 1.51] |
Trial | Treatments | Patients | Method |
---|
THRIVE III, 2003 | ximelagatran 24 mg twice daily for 18 months (n=612) vs. placebo for 18 months (n=611) | patients with venous thromboembolism who had undergone six months of anticoagulant therapy | double blind Parallel groups Sample size: 612/611 Primary endpoint: symptomatic recurrent venous FU duration: 18 months |
|
antithrombotics | ximelagatran | versus placebo No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Schulman (subgroup), 2003 | ximelagatran vs placebo | | | |
Trial | Treatments | Patients | Method |
---|
Schulman (subgroup), 2003 | extended treatment with Ximelagatran 24mg twice daily after initial anticoagulant treatment for 6 months (n=-9) vs. placebo (initial anticoagulant treatment for 6 months) (n=-9) | study subgroup of patients with active cancer in the previous 5 years treated for DVT or pulmonary
embolism for 6 months without recurrence | single blind and outcome ass. Parallel groups Sample size: -9/-9 Primary endpoint: FU duration: 18 months |
|
antithrombotics | ximelagatran | versus No demonstrated result for efficacy | 2 trials | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
THRIVE I, 2003 | ximelagatran (without LMWH) vs LMWH/VKA | | | | Fiessinger , 2005 | ximelagatran vs LMWH/VKA | | | |
Trial | Treatments | Patients | Method |
---|
THRIVE I, 2003 | oral ximelagatran (24, 36, 48 or 60 mg twice daily) for 2 weeks (n=-9) vs. dalteparin and warfarin for 2 weeks (n=-9) | Patients with acute DVT | Sample size: -9/-9 Primary endpoint: FU duration: | Fiessinger , 2005 | ximelagatran 36 mg twice daily (n=-9) vs. subcutaneous enoxaparin, 1 mg/kg twice daily, for 5 to 20 days followed by warfarin adjusted to maintain an international normalized ratio of 2.0 to 3.0. (n=-9) | patients with acute deep vein thrombosis | double blind Sample size: -9/-9 Primary endpoint: 28 countries FU duration: |
|
caval filter | caval filter | versus No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
PREPIC, 1998 | caval filter vs no filter | pulmonary embolims (symptomatic and asymptomatic) 0.22 [0.05; 0.93] | | death 1.00 [0.29; 3.40] major bleeding 1.50 [0.54; 4.14] asymptomatic pulmonary embolism 0.00 [0.00; NaN] symptomatic pulmonary embolism 0.40 [0.08; 2.04] |
Trial | Treatments | Patients | Method |
---|
PREPIC, 1998 | caval filter (n=200) vs. no filter (n=200) 2x2 factorial design also comparing LMWH vs unfractionated heparin | patients with documented proximal DVT or PE, and considered high risk for pulmonary
embolism | open Parallel groups Sample size: 200/200 Primary endpoint: none FU duration: 12 days and 2 years |
|
direct oral anticoagulant (DAO) | apixaban | versus discontinuation No demonstrated result for efficacy | 2 trials | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
AMPLIFY-EXT 2.5mg, 2012 | apixaban 2.5mg vs discontinuation | recurrent VTE 0.33 [0.22; 0.49] | | Major bleeding 0.49 [0.09; 2.69] major or clinically
relevant nonmajor bleeding 1.21 [0.70; 2.11] | AMPLIFY-EXT 5mg, 2012 | apixaban 5mg vs discontinuation | recurrent VTE 0.36 [0.25; 0.53] | | Major bleeding 0.25 [0.03; 2.28] major or clinically
relevant nonmajor bleeding 1.62 [0.96; 2.74] |
Trial | Treatments | Patients | Method |
---|
AMPLIFY-EXT 2.5mg, 2012 | Extended Treatment with apixaban 2.5 mg twice daily 12 months (n=842) vs. placebo (n=829) 3 arms: apixaban 2.5mg, 5mg twice daily, placebo | patients who have completed their intended treatment for deep vein thrombosis or pulmonary embolism | double blind Parallel groups Sample size: 842/829 Primary endpoint: FU duration: 12 mo | AMPLIFY-EXT 5mg, 2012 | Extended Treatment with apixaban 5 mg twice daily 12 months
(n=815) vs. placebo
(n=829) 3 arms: apixaban 2.5mg, 5mg twice daily, placebo
| patients who have completed their intended treatment for deep vein thrombosis or pulmonary embolism
| double blind Sample size: 815/829 Primary endpoint: FU duration: 12 mo
|
|
direct oral anticoagulant (DAO) | apixaban | versus heparin/VKA No demonstrated result for efficacy | 2 trials | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Botticelli DVT, 2008 | apixaban (without LMWH) vs LMWH/VKA | | | | AMPLIFY, 2013 | apixaban (without LMWH) vs LMWH/VKA | Major bleeding 0.31 [0.17; 0.55] | | recurrent DVT only 0.61 [0.35; 1.06] death 0.79 [0.53; 1.19] All deaths 0.79 [0.53; 1.19] non fatal PE 1.19 [0.68; 2.06] fatal PE 0.50 [0.05; 5.57] Symptomatic nonfatal pulmonary embolism 1.19 [0.68; 2.06] recurrent VTE during treatment 0.84 [0.60; 1.18] Symptomatic deep-vein thrombosis 0.61 [0.35; 1.06] Death related to venous thromboembolism 0.85 [0.38; 1.90] recurrent VTE 0.84 [0.60; 1.18] |
Trial | Treatments | Patients | Method |
---|
Botticelli DVT, 2008 | apixaban 5 mg twice-daily, 10 mg twice-daily, or 20 mg once-daily for 84-91 days (n=358) vs. low molecular weight heparin followed by vitamin K antagonists (n=118) | patients with symptomatic deep vein thrombosis | open Parallel groups Sample size: 358/118 Primary endpoint: recurrent VTE or asymptomatic deterioration in the FU duration: dose-ranging study;
the primary efficacy endpoint was the composite of symptomatic recurrent venous thromboembolism and asymptomatic deterioration of bilateral compression ultrasound or perfusion lung scan | AMPLIFY, 2013 | apixaban 10 mg twice daily for 7 days then 5 mg, twice daily, 6 months (n=2691) vs. conventional
therapy: enoxaparin 1mg/kg twice daily until INR>=2 then warfarin for an INR between 2-4, once daikly, 6 months (n=2704) | patients with deep vein thrombosis or pulmonary embolism | double blind Parallel groups Sample size: 2691/2704 Primary endpoint: Venous thromboembolic recurrence or death FU duration: 6 mo |
|
direct oral anticoagulant (DAO) | dabigatran | versus warfarin No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
RE-MEDY, 2011 | dabigatran vs warfarin | any bleeding 0.74 [0.65; 0.85] major or clinically
relevant nonmajor bleeding 0.55 [0.42; 0.72] | | All deaths 0.89 [0.47; 1.71] Major bleeding 0.52 [0.27; 1.01] Symptomatic nonfatal pulmonary embolism 1.99 [0.68; 5.82] recurrent VTE during treatment 1.44 [0.79; 2.62] Death related to venous thromboembolism 1.00 [0.06; 15.93] recurrent VTE 1.44 [0.79; 2.62] |
Trial | Treatments | Patients | Method |
---|
RE-MEDY, 2011 | dabigatran 150 mg twice daily for an additional period of 6 to 36 months (n=1430) vs. warfarin (to maintain an international normalized ratio of 2.0 to 3.0) for an additional period of 6 to 36 months (n=1426) dabigatran 150 mg twice daily or with warfarin (to maintain an international normalized ratio of 2.0 to 3.0) for an additional period of 6 to 36 months after 3 to 12 months of anticoagulant therapy | Secondary prevention of VTE in patients with VTE who had initially received 3 to 12 months of anticoagulant therapy | double-blind Parallel groups Sample size: 1430/1426 Primary endpoint: recurrent symptomatic VTE and related deaths FU duration: 6 to 36 months |
|
direct oral anticoagulant (DAO) | dabigatran | versus discontinuation No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
RE-SONATE, 2011 | dabigatran vs discontinuation | recurrent VTE during treatment 0.08 [0.02; 0.25] recurrent VTE 0.08 [0.02; 0.25] | | All deaths 0.00 [0.00; NaN] Major bleeding ∞ [NaN; ∞] |
Trial | Treatments | Patients | Method |
---|
RE-SONATE, 2011 | dabigatran 150 mg twice daily for an additional period of 6 months (n=681) vs. placebo (n=662) patients randomized after 6-18 months of anticoagulant therapy | Secondary prevention of VTE in patients with VTE who had completed 6-18 months of anticoagulant therapy | double-blind Parallel groups Sample size: 681/662 Primary endpoint: recurrent symptomatic VTE and related deaths FU duration: |
|
direct oral anticoagulant (DAO) | dabigatran | versus heparin/VKA No demonstrated result for efficacy | 2 trials | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
RE-COVER, 2009 | heparin/dabigatran vs heparin/VKA | any bleeding 0.73 [0.62; 0.86] | | All deaths 0.99 [0.55; 1.81] Major bleeding 0.83 [0.46; 1.49] Symptomatic nonfatal pulmonary embolism 1.84 [0.74; 4.61] recurrent VTE during treatment 1.10 [0.66; 1.84] Symptomatic deep-vein thrombosis 0.88 [0.45; 1.72] Death related to venous thromboembolism 0.33 [0.03; 3.18] recurrent VTE 1.05 [0.66; 1.70] | RE-COVER II, 2011 | heparin/dabigatran vs heparin/VKA | any bleeding 0.71 [0.60; 0.84] | | death 1.01 [0.59; 1.76] Major bleeding 0.69 [0.36; 1.33] recurrent VTE during treatment 1.09 [0.65; 1.81] recurrent VTE 1.09 [0.65; 1.81] |
Trial | Treatments | Patients | Method |
---|
RE-COVER, 2009 | dabigatran 150 mg twice daily in a fixed-dose (n=1274) vs. warfarin dose-adjusted to an INR between 2.0 and 3.0 (n=1265) | patients with acute venous thromboembolism , treated with low molecular weight or unfractionated heparin for 5 to 11 days | double blind Parallel groups Sample size: 1274/1265 Primary endpoint: recurrent VTE or VTE-related death FU duration: 6 months | RE-COVER II, 2011 | dabigatran, 150 mg twice daily, for 6 months (n=1294) vs. warfarin, dose-adjusted to an INR of 2.0 and 3.0, for 6 months (n=1295) | patients with acute VTE, treated with low molecular weight or unfractionated heparin for 5 to 11 days | double-blind Parallel groups Sample size: 1294/1295 Primary endpoint: symptomatic recurrence + related death FU duration: 6 months |
|
direct oral anticoagulant (DAO) | edoxaban | versus heparin/VKA No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Edoxaban Hokusai VTE, 2013 | heparin/edoxaban vs heparin/VKA | any bleeding 0.85 [0.79; 0.92] major or clinically
relevant nonmajor bleeding 0.83 [0.72; 0.95] | | recurrent DVT only 0.89 [0.71; 1.12] Major bleeding 0.85 [0.60; 1.21] non fatal PE 0.83 [0.57; 1.21] fatal PE 1.34 [0.30; 5.96] recurrent VTE during treatment 0.83 [0.60; 1.14] |
Trial | Treatments | Patients | Method |
---|
Edoxaban Hokusai VTE, 2013 | heparin then edoxaban 60mg daily (30mg if creatine clearnce of 30 to 50 ml/min or <60kg) for 3 to 12 months (n=4143) vs. heparin then warfarin (n=4149) | patients
with acute venous thromboembolism, who had initially received heparin, | double-blind Parallel groups Sample size: 4143/4149 Primary endpoint: recurrent symptomatic venous thromboembolism FU duration: |
|
direct oral anticoagulant (DAO) | fondaparinux | versus heparin/VKA No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
MATISSE PE, 2003 | fondaparinux vs heparin | | | recurrent DVT only 0.71 [0.34; 1.48] All deaths 1.19 [0.82; 1.73] Major bleeding 0.85 [0.48; 1.48] non fatal PE 0.59 [0.31; 1.13] fatal PE 1.07 [0.53; 2.16] recurrent VTE 0.75 [0.51; 1.12] |
Trial | Treatments | Patients | Method |
---|
MATISSE PE, 2003 | fondaparinux subcutaneously once daily (n=1103) vs. continuous intravenous infusion of unfractionated
heparin (n=1110) | patients with acute symptomatic pulmonary embolism | open Parallel groups Sample size: 1103/1110 Primary endpoint: symptomatic recurrent/new VTE FU duration: 3 mo |
|
direct oral anticoagulant (DAO) | idraparinux | versus heparin/VKA No demonstrated result for efficacy idraparinux (without heparin) inferior to heparin/VKA in terms of All deaths in VanGogh PE, 2007 idraparinux (without heparin) inferior to heparin/VKA in terms of non fatal PE in VanGogh PE, 2007 idraparinux (without heparin) inferior to heparin/VKA in terms of recurrent VTE in VanGogh PE, 2007 | 2 trials | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
VanGogh DVT, 2007 | idraparinux (without heparin) vs heparin/VKA | any bleeding 0.64 [0.48; 0.87] | | recurrent DVT only 0.94 [0.49; 1.83] All deaths 1.03 [0.64; 1.67] Major bleeding 0.71 [0.34; 1.47] non fatal PE 0.95 [0.53; 1.73] fatal PE 1.00 [0.25; 3.99] recurrent VTE during treatment 0.98 [0.64; 1.48] recurrent VTE 0.98 [0.64; 1.48] | VanGogh PE, 2007 | idraparinux (without heparin) vs heparin/VKA | | All deaths 1.79 [1.17; 2.74] non fatal PE 5.11 [1.48; 17.62] recurrent VTE 2.10 [1.20; 3.67] | recurrent DVT only 1.02 [0.43; 2.45] Major bleeding 0.51 [0.26; 1.02] fatal PE 2.45 [0.87; 6.94] |
Trial | Treatments | Patients | Method |
---|
VanGogh DVT, 2007 | subcutaneous idraparinux (2.5 mg once weekly) (n=1452) vs. heparin followed by an adjusted-dose vitamin K antagonist (n=1452) | patients with deep-vein thrombosis | open Parallel groups Sample size: 1452/1452 Primary endpoint: 3-month incidence of symptomatic recurrent venous thromboembolism (nonfatal or fatal) FU duration: 3 mo (6 mo) | VanGogh PE, 2007 | subcutaneous idraparinux (2.5 mg once weekly)
(n=1095) vs. heparin followed by an adjusted-dose vitamin K antagonist
(n=1120)
|
patients with pulmonary embolism
| open Parallel groups Sample size: 1095/1120 Primary endpoint: 3-month incidence of symptomatic recurrent venous thromboembolism (nonfatal or fatal) FU duration: 3 mo (6 mo)
|
|
direct oral anticoagulant (DAO) | rivaroxaban | versus discontinuation No demonstrated result for efficacy rivaroxaban inferior to discontinuation in terms of major or clinically
relevant nonmajor bleeding in EINSTEIN-extension, 2009 | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
EINSTEIN-extension, 2009 | rivaroxaban vs discontinuation | recurrent DVT only 0.16 [0.06; 0.41] non fatal PE 0.15 [0.03; 0.67] recurrent VTE 0.19 [0.09; 0.40] | major or clinically
relevant nonmajor bleeding 5.07 [2.28; 11.31] | death 0.49 [0.04; 5.43] All deaths 0.49 [0.04; 5.43] Major bleeding ∞ [NaN; ∞] fatal PE 0.00 [0.00; NaN] Death related to venous thromboembolism 0.99 [0.06; 15.74] |
Trial | Treatments | Patients | Method |
---|
EINSTEIN-extension, 2009 | rivaroxaban 20 mg once-daily for an additional 6 or 12 months (n=602) vs. placebo (n=595) | patients who had completed six to 12 months of anticoagulant treatment for an acute episode of VTE | double blind Parallel groups Sample size: 602/595 Primary endpoint: symptomatic recurrent VTE FU duration: |
|
direct oral anticoagulant (DAO) | rivaroxaban | versus heparin/VKA No demonstrated result for efficacy | 3 trials | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Einstein-DVT Dose-Ranging Study, 2008 | rivaroxaban (without LMWH) vs LMWH/VKA | | | | Einstein-DVT Evaluation, 2010 | rivaroxaban (without LMWH) vs LMWH/VKA | recurrent DVT only 0.50 [0.26; 0.94] | | All deaths 0.77 [0.51; 1.17] Major bleeding 0.70 [0.35; 1.38] non fatal PE 1.10 [0.59; 2.08] fatal PE ∞ [NaN; ∞] Symptomatic nonfatal pulmonary embolism 1.10 [0.59; 2.08] recurrent VTE during treatment 0.70 [0.46; 1.07] Death related to venous thromboembolism 0.66 [0.19; 2.35] recurrent VTE 0.70 [0.46; 1.07] | Einstein-PE Evaluation, 2012 | rivaroxaban (without LMWH) vs LMWH/VKA | | | |
Trial | Treatments | Patients | Method |
---|
Einstein-DVT Dose-Ranging Study, 2008 | rivaroxaban 20, 30, or 40 mg once daily (n=-9) vs. low-molecular-weight heparin followed by vitamin K antagonists (n=-9) | patients with deep vein thrombosis | open Sample size: -9/-9 Primary endpoint: FU duration: | Einstein-DVT Evaluation, 2010 | rivaroxaban 15 mg twice daily for 3 weeks, then 20 mg daily (n=1731) vs. enoxaparin 1 mg/kg twice daily >=5 days, then warfarin with target INR between 2-3 (n=1718) treatment duration (3, 6, or 12 months) decided by physicians. treatment duration of 6 months in 63%, 3 mo in 12% and 12 mo in 25% | Patients with Confirmed Acute Symptomatic Deep-Vein Thrombosis without Pulmonary Embolism | open (assessor-blind) Parallel groups Sample size: 1731/1718 Primary endpoint: Symptomatic recurrent VTE FU duration: | Einstein-PE Evaluation, 2012 | rivaroxaban (15 mg twice daily for 3 weeks, followed by 20 mg once daily) for 3, 6, or 12 months (n=2419) vs. standard therapy with enoxaparin followed by an adjusted-dose vitamin
K antagonist (n=2413) | patients
who had acute symptomatic pulmonary embolism with or without deep-vein thrombosis | open Parallel groups Sample size: 2419/2413 Primary endpoint: symptomatic recurrent venous thromboembolism FU duration: 9.8 months |
|
direct oral anticoagulant (DAO) | rosuvastatin | versus discontinuation No demonstrated result for efficacy idraparinux inferior to discontinuation in terms of major or clinically
relevant nonmajor bleeding in VanGogh extension, 2007 | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
VanGogh extension, 2007 | idraparinux vs discontinuation | death 0.25 [0.08; 0.79] non fatal PE 0.10 [0.01; 0.73] recurrent VTE 0.27 [0.11; 0.67] | major or clinically
relevant nonmajor bleeding 3.11 [1.48; 6.56] | recurrent DVT only 0.29 [0.08; 1.02] Major bleeding ∞ [NaN; ∞] fatal PE 2.09 [0.19; 23.00] |
Trial | Treatments | Patients | Method |
---|
VanGogh extension, 2007 | once-weekly injections of 2.5 mg of idraparinux for 6 months (n=594) vs. placebo (n=621) | patients who had completed 6 months of prophylaxis with
idraparinux or a vitamin K antagonist and in whom extended anticoagulation was
warranted | Parallel groups Sample size: 594/621 Primary endpoint: FU duration: 6 months |
|
fibrinolysis | heparin | versus No demonstrated result for efficacy | 1 trial | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Schweizer tPA, 1998 | tPA+heparin vs no fibrinolysis | | | Bleeding (early) ∞ [NaN; ∞] Complete clot lysis (late) 1.25 [0.61; 2.56] Post-thrombotic syndrome (late) 0.82 [0.56; 1.21] Leg ulceration (late) 2.00 [0.20; 20.49] Stroke/intracerebral bleeding (eraly) NaN [NaN; NaN] |
Trial | Treatments | Patients | Method |
---|
Schweizer tPA, 1998 | tPA 20 mg IV into pedal vein over 4 hours each day for 7 days. Heparin IV given
concomitantly, with adjustment (n=-9) vs. heparin IV, adjusted for 7 days (n=-9) | patients with venographically confirmed DVT of leg duration < 7 days. | single blind Parallel groups Sample size: -9/-9 Primary endpoint: FU duration: |
|
fibrinolysis | streptokinase | versus No demonstrated result for efficacy streptokinase inferior to no fibrinolysis in terms of Any improvement in venous patency (early) in Arneson, 1978 streptokinase inferior to no fibrinolysis in terms of Normal venous function (late) in Elsharawy, 2002 streptokinase inferior to no fibrinolysis in terms of Complete clot lysis (late) in Elsharawy, 2002 | 7 trials | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Arneson, 1978 | streptokinase vs no fibrinolysis | | Any improvement in venous patency (early) 3.00 [1.33; 6.75] | Mortality (early) 0.00 [0.00; NaN] Pulmonary embolism (early) 1.00 [0.07; 14.96] Bleeding (early) 1.00 [0.29; 3.48] Complete clot lysis (late) ∞ [NaN; ∞] Post-thrombotic syndrome (late) 0.47 [0.18; 1.25] Mortality (late) 1.33 [0.34; 5.24] Leg ulceration (late) 0.00 [0.00; NaN] Stroke/intracerebral bleeding (eraly) NaN [NaN; NaN] | Common, 1976 | streptokinase vs no fibrinolysis | | | Complete clot lysis (early) 6.78 [0.88; 52.23] Mortality (early) ∞ [NaN; ∞] Bleeding (early) 1.58 [0.58; 4.31] Any improvement in venous patency (early) 1.35 [0.92; 1.98] Complete clot lysis (late) 4.80 [0.67; 34.64] Stroke/intracerebral bleeding (eraly) ∞ [NaN; ∞] | Elsharawy, 2002 | streptokinase vs no fibrinolysis | | Normal venous function (late) 6.14 [1.62; 23.28] Complete clot lysis (late) 6.14 [1.62; 23.28] | Complete clot lysis (early) ∞ [NaN; ∞] Mortality (early) NaN [NaN; NaN] Pulmonary embolism (early) 0.00 [0.00; NaN] Bleeding (early) NaN [NaN; NaN] Any improvement in venous patency (early) ∞ [NaN; ∞] Stroke/intracerebral bleeding (eraly) NaN [NaN; NaN] | Schulman, 1986 | streptokinase vs no fibrinolysis | | | Complete clot lysis (early) 1.24 [0.59; 2.60] Mortality (early) 1.12 [0.08; 16.52] Pulmonary embolism (early) NaN [NaN; NaN] Bleeding (early) 3.35 [0.38; 29.27] Normal venous function (late) 1.04 [0.59; 1.83] Complete clot lysis (late) 1.47 [0.77; 2.79] Leg ulceration (late) NaN [NaN; NaN] Stroke/intracerebral bleeding (eraly) NaN [NaN; NaN] | Tsapogas, 1973 | streptokinase vs no fibrinolysis | | | Stroke/intracerebral bleeding (eraly) NaN [NaN; NaN] | Kakkar (streptokinase), 1969 | streptokinase vs no fibrinolysis | | | Complete clot lysis (early) 3.00 [0.81; 11.08] Mortality (early) 1.00 [0.17; 5.77] Pulmonary embolism (early) 0.00 [0.00; NaN] Bleeding (early) 1.80 [0.43; 7.59] Any improvement in venous patency (early) 1.75 [0.78; 3.93] Stroke/intracerebral bleeding (eraly) NaN [NaN; NaN] | Schweizer (systemic SK), 2000 | streptokinase vs no fibrinolysis | | | |
Trial | Treatments | Patients | Method |
---|
Arneson, 1978 | streptokinase 250,000 U loading IV, then 100,000 IU/hour IV 72-96 hours
(n=43) vs. heparin 15,000 IU IV bolus, 30,000 IU infusion IV 72-90 hours¢ßl (n=0) | inpatients with venographically confirmed DVT extending proximally beyond the calf <5 days duration? | single blind Parallel groups Sample size: 43/0 Primary endpoint: FU duration: | Common, 1976 | hydrocortisone 100 mg IV then streptokinase IV 250,000 U over 30 minutes, then 100,000
U/hour titrated for 72 hours. Followed by IV heparin titrated over 7 days (n=50) vs. IV heparin 150 U/kg loading dose then titrated for 10 days (n=0) | patients with venographically confirmed DVT duration < 14 days | single blind Parallel groups Sample size: 50/0 Primary endpoint: FU duration: | Elsharawy, 2002 | catheter-directed thrombolysis with streptokinase using popliteal approach. (n=35) vs. heparin IV bolus 5000 U, then adjusted continuous infusion. Warfarin begun the same evening (n=0) | iliofemoral venous thrombosis confirmed by duplex or venography duration < 10 daysicatio | single blind Parallel groups Sample size: 35/0 Primary endpoint: FU duration: | Schulman, 1986 | streptokinase 50,000 IU IV over 15 minutes then 100,000 IU over 12 hours for up to 7 days,
titrated. Given with 5000 IU heparin IV over 12 hours. Warfarin begun after streptokinase ended (n=38) vs. heparin 5000 IUIVbolus then 30,000 IUper day, titrated for 7 days.Warfarin begun simultaneously (n=0) | patients with venographically confirmed calf vein thrombosis of duration < 7 days. | single blind Parallel groups Sample size: 38/0 Primary endpoint: FU duration: | Tsapogas, 1973 | titrated dose of streptokinase IV into ankle veinmage/pj (n=34) vs. heparin IV into affected limbitm (n=0) | patients with DVT confirmed by venogram of duration < 5 days. | open Parallel groups Sample size: 34/0 Primary endpoint: FU duration: | Kakkar (streptokinase), 1969 | streptokinase 500,000 U IV over 30 minutes, 900,000 U every 6 hours for 5 days (n=-9) vs. heparin 10,000 U over 5 minutes, then 10,000 to 15,000 U every 6 hours for 5 dayslicatio (n=-9) | patients with venographically confirmed DVT of leg of duration < 4 days | single blind Parallel groups Sample size: -9/-9 Primary endpoint: FU duration: | Schweizer (systemic SK), 2000 | Systemic streptokinase 3,000,000 U/day over 6 hours in conjunction with heparin for up to 7 days. Premedication: hydrocortisone 100 mg, ranitidine 50 mg, clemastine 2 mg (n=-9) vs. heparin IV, adjusted (n=-9) | patients with thrombosis of popliteal or more proximal veins confirmed by venogram at more than one level of duration < 9 days | single blind Parallel groups Sample size: -9/-9 Primary endpoint: FU duration: |
|
fibrinolysis | t-pa | versus No demonstrated result for efficacy tPA inferior to no fibrinolysis in terms of Any improvement in venous patency (early) in Turpie, 1990 | 6 trials | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Goldhaber (tPA alone), 1990 | tPA vs no fibrinolysis | | | Bleeding (early) ∞ [NaN; ∞] Any improvement in venous patency (early) 3.28 [0.90; 11.91] | Schweizer (local tPA), 2000 | tPA vs no fibrinolysis | | | | Turpie, 1990 | tPA vs no fibrinolysis | | Any improvement in venous patency (early) 2.57 [1.35; 4.88] | Bleeding (early) 2.56 [0.53; 12.46] Stroke/intracerebral bleeding (eraly) NaN [NaN; NaN] | Verhaeghe (high dose), 1989 | tPA vs no fibrinolysis | | | | Goldhaber (tPA+heparin), 1990 | tPA vs no fibrinolysis | | | | Verhaeghe (low dose), 1989 | tPA vs no fibrinolysis | | | |
Trial | Treatments | Patients | Method |
---|
Goldhaber (tPA alone), 1990 | tPA alone 0.05 mg/kg/hour IV over 24 hours, then heparin100U/kg bolus, then 1000 U/hour, adjusted (n=-9) vs. heparin alone 100 U/kg bolus, then 1000 U/hour (n=-9) | venographically documented DVT, in popliteal ormore proximal veins < 14 days duration | single blind Parallel groups Sample size: -9/-9 Primary endpoint: FU duration: | Schweizer (local tPA), 2000 | local tPA 20 mg/day, over 4 hours via pedal vein for 4-7 days. IV heparin given
simultaneously at 1000 IU/hour, adjusted (n=-9) vs. heparin IV, adjusted (n=-9) | patients with thrombosis of popliteal or more proximal veins confirmed by venogram at more than one level of duration < 9 days | single blind Parallel groups Sample size: -9/-9 Primary endpoint: FU duration: | Turpie, 1990 | tPA + IV heparin (n=83) vs. 5000 U bolus then 30,000 U/24 hours, adjusted for 7-10 days (+placebo) (n=0) | patients with venographically confirmed proximal DVT of lower limb of duration < 7 days | double blind Parallel groups Sample size: 83/0 Primary endpoint: FU duration: | Verhaeghe (high dose), 1989 | IV tPA 100 mg on day 1, 50 mg tPA on day 2. 10% of dose given as bolus; heparin 5000 U IV bolus then continuous infusion of 1000 U per hour for up to 72 hours (n=-9) vs. heparin 5000 U IV bolus then continuous infusion of 1000 U per hour for up to 72 hours (+placebo) (n=-9) | hospitalised patients with DVT of popliteal or more proximal veins of the lower leg, confirmed by venography of duration < 10 days. | double blind Parallel groups Sample size: -9/-9 Primary endpoint: FU duration: | Goldhaber (tPA+heparin), 1990 | tPA 0.05 mg/kg/hour IV over 24 hours and heparin 100U/kg bolus, then 1000 U/hour, adjusted (n=-9) vs. heparin alone 100 U/kg bolus, then 1000 U/hour. (n=-9) | patients with venographically documented DVT, in popliteal ormore proximal veins < 14 days duration | single blind Parallel groups Sample size: -9/-9 Primary endpoint: FU duration: | Verhaeghe (low dose), 1989 | IV tPA 50 mg on day 1, repeated on day 2. 10% of dose given as bolus; heparin 5000 U IV bolus then continuous infusion of 1000 U per hour for up to 72 hours (n=-9) vs. heparin 5000 U IV bolus then continuous infusion of 1000 U per hour for up to 72 hours (+placebo) (n=-9) | hospitalised patients with DVT of popliteal or more proximal veins of the lower leg, confirmed by venography of duration < 10 days. | double blind Parallel groups Sample size: -9/-9 Primary endpoint: FU duration: |
|
fibrinolysis | urokinase | versus No demonstrated result for efficacy urokinase inferior to no fibrinolysis in terms of Complete clot lysis (late) in Schweizer (urokinase), 1998 | 4 trials | meta-analysis | | Trial | control | p<0.05 | harm | NS |
---|
Kiil, 1981 | urokinase vs no fibrinolysis | | | Mortality (early) 0.00 [0.00; NaN] Bleeding (early) 0.61 [0.18; 2.06] Any improvement in venous patency (early) 0.73 [0.05; 9.97] Stroke/intracerebral bleeding (eraly) NaN [NaN; NaN] | Schweizer (urokinase), 1998 | urokinase vs no fibrinolysis | | Complete clot lysis (late) 2.13 [1.17; 3.86] | Mortality (early) ∞ [NaN; ∞] Post-thrombotic syndrome (late) 0.65 [0.40; 1.04] Leg ulceration (late) 1.00 [0.07; 15.00] Stroke/intracerebral bleeding (eraly) NaN [NaN; NaN] | Schweizer (local urokinase), 2000 | urokinase vs no fibrinolysis | | | | Schweizer (systemic urokinase), 2000 | urokinase vs no fibrinolysis | | | |
Trial | Treatments | Patients | Method |
---|
Kiil, 1981 | urokinase 200,000 U IV over 24 hours. After 18 hours, heparin loading dose of 15,000 units
then 40,000 U/day for 5 days (+placebo) (n=20) vs. heparin 40,000 U/day IV for 6 days (+placebo) (n=0) | patients with venographically confirmed DVT duration < 72 hours | Double blind Parallel groups Sample size: 20/0 Primary endpoint: FU duration: | Schweizer (urokinase), 1998 | Urokinase 100,000 IU/hr IV into pedal vein continuously for 7 days. Heparin IV for 7 days. Plasminogen
monitored. Warfarin from day 7 to 12 monthsd=132 (n=-9) vs. heparin IV, adjusted for 7 days (n=-9) | patients with venographically confirmed DVT of leg duration < 7 days | single blind Parallel groups Sample size: -9/-9 Primary endpoint: FU duration: | Schweizer (local urokinase), 2000 | Local urokinase 100,000 IU/day infused continuously. Fibrinogen and plasminogen monitored. Heparin IV given concomitantly (n=-9) vs. heparin IV, adjusted (n=-9) | patients with thrombosis of popliteal or more proximal veins confirmed by venogram at more than one level of duration < 9 days | single blind Parallel groups Sample size: -9/-9 Primary endpoint: FU duration: | Schweizer (systemic urokinase), 2000 | Systemic urokinase 5,000,000 IU/day over 4 hours for up to 7 days. IV heparin given concomitantly (n=-9) vs. heparin IV, adjusted (n=-9) | patients with thrombosis of popliteal or more proximal veins confirmed by venogram at more than one level of duration < 9 days | single blind Parallel groups Sample size: -9/-9 Primary endpoint: FU duration: |
|