Review on Efficacy and Safety of Newer Oral Anticoagulants for Deep Vein Thrombosis Patient

  • Ridwan Rasyid Departement of Cardiology and Vascular Medicine, Faculty of Medi-cine University of Indonesia, and National Cardiovascular Center Harapan Kita, Jakarta
  • Pringgodigdo Nugroho Departement of Cardiology and Vascular Medicine, Faculty of Medi-cine University of Indonesia, and National Cardiovascular Center Harapan Kita, Jakarta
  • Yoga Yuniadi Departement of Cardiology and Vascular Medicine, Faculty of Medi-cine University of Indonesia, and National Cardiovascular Center Harapan Kita, Jakarta
DOI: https://doi.org/10.30701/ijc.v33i4.31

Abstract

Background. Warfarin is a standard medication for deep vein thrombosis (DVT). However, there are some limitations of its use due to the need of regular monitoring and problems of drug to drug and drug to food interactions. Newer  oral anticoagulants (NOAC) is being considered as substitution to warfarin, yet they need some evidences on its safety and efficacy. This evidence case report is aimed to elaborate safety and efficacy of NOAC (dabigatran and rivaroxaban) in the setting of DVT.

Methods  and Results.  Relevant articles are searched in Pubmed and Proquest database. Only recent article which less than 5 year publication included in this study. RE-COVER  study showed  non-inferiority of dabigatran as compare to warfarin in treating DVT patients. Mortality rate and recurrent rate of DVT were 2.4% vs. 2.1% in dabigatran and warfarin respectively (HR=1,10 CI 95%  = 0,65-1,84). Dabigatran showed less bleeding rate compare to warfarin, 5.6% vs. 8.8% respectively (HR = 0,63

CI95% = 0,47 - 0,84; RRR =29%, p = 0,0002). Similar results is shown in EINSTEIN study that compares rivaroxaban with warfarin. Mortality rate and recurrent rate of DVT were 2.1% vs. 3% in rivaroxaban and warfarin respectively (HR=0,68  CI 95% = 0,44-1,04). Total bleeding rate were

7.3% vs. 7% and major bleeding were 0.8% vs. 1.2% in rivaroxaban and warfarin respectively.

Conclusion. Both dabigatran and rivaroxaban showed non inferior efficacy as compare to warfarin in the treatment of DVT, and slightly better bleeding rate.

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References

Schulman S, Kearon C, Kakkar AK, Mismetti P, Schellong S, Eriksson H, et al for the RE-COVER Study Group. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med. 2009; 361: 2342-52.

The EINSTEIN Investigators. Oral Rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 2010;363:2499-510.

Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, and the RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139-51.

Keisu M, Andersson TB. Drug-induced liver injuryin humans: the case of ximelagatran. Handb Exp Pharmacol. 2010;196:407-18.
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How to Cite
Rasyid, R., Nugroho, P., & Yuniadi, Y. (1). Review on Efficacy and Safety of Newer Oral Anticoagulants for Deep Vein Thrombosis Patient. Indonesian Journal of Cardiology, 33(4), 244-51. https://doi.org/10.30701/ijc.v33i4.31
Issue
Vol. 33, No. 4 Oktober - Desember 2012
Section
Case Reports

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