Abstract
SESSION TITLE: Pulmonary Vascular Disease 1 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: To address the relationship between age and the efficacy and safety of the direct oral anticoagulants (DOACs), we performed a systematic review and meta-analysis to evaluate the incidence of recurrent venous thromboembolism (VTE) in non-elderly (less than or equal to 65 years) versus elderly patients (greater than 65 years) with acute VTE treated with DOACs compared to vitamin K antagonists (VKAs). Previous meta-analyses evaluated this using age cutoffs of greater than or less than 75 years, with the former group making up a small portion of the study population in the respective DOAC trials. METHODS: We searched several databases from inception until 1 November 2017 for comparative studies evaluating the use of DOACs in preventing recurrent VTE in elderly versus non-elderly patients.. Search terms included 'novel oral anticoagulant', 'vitamin K antagonist', 'warfarin', and/or venous thromboembolism. The outcome of interest was recurrent VTE. Pooled risk ratios (RR) were pooled and analyzed using a random effects model. RESULTS: Eight studies including 26,350 patients were included in this analysis. For incidence of recurrent VTE in the study population, pooled RR was 0.87 (0.60 - 1.24). For recurrent VTE in non-elderly patients, pooled RR was 0.52 (0.27 - 0.99). Significant heterogeneity of 91% was noted for this outcome. For recurrent VTE in elderly patients, pooled RR was 0.56 (0.33 - 0.94). Significant heterogeneity of 71% was noted for this outcome. The heterogeneity persisted for recurrent VTE in both elderly and non-elderly patients despite adjusting for specific DOAC used. CONCLUSIONS: Moderate-to-high quality evidence suggests DOAC use was associated with a statistically significant reduction in the incidence of recurrent VTE in elderly and non-elderly patients. Significant heterogeneity noted for the outcome of interest indicates the reduction in VTE could be due to chance. CLINICAL IMPLICATIONS: Further randomized trials with elderly and non-elderly patients are needed to determine if DOAC use in patients with VTE is truly non-inferior to warfarin in this important subgroup of patients. DISCLOSURES: No relevant relationships by Christopher Jackson, source=Web Response No relevant relationships by Ankur Seth, source=Web Response
Published Version
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