Risk of post-thrombotic syndrome after deep vein thrombosis treated with rivaroxaban versus vitamin-K antagonists: A systematic review and meta-analysis

Thromb Res. 2020 Dec:196:340-348. doi: 10.1016/j.thromres.2020.09.014. Epub 2020 Sep 17.

Abstract

Introduction: Post-thrombotic syndrome (PTS) is a burdensome long-term complication of deep vein thrombosis (DVT). Recent studies have suggested that rivaroxaban may reduce PTS events compared to vitamin-K antagonists (VKAs). We, therefore, systematically reviewed available literature that compared rivaroxaban versus VKAs on the risk of PTS.

Materials and methods: We conducted a systematic review and meta-analysis using PubMed, EMBASE and Cochrane Library for all related studies from inception until March 2020. Two reviewers independently screened studies, extracted data, and appraised the quality of included studies. The primary outcome was overall risk of PTS. The secondary outcomes were risks of each PTS category (mild, moderate, severe) and venous ulcer.

Results: Seven comparative studies, comprising 2364 participants, qualified for this meta-analysis. The use of rivaroxaban for DVT treatment was associated with a lower risk of PTS compared with conventional VKAs [pooled unadjusted odds ratio (OR): 0.53, 95%CI: 0.43-0.65, P < 0.00001]. This effect was maintained after adjustment of potential confounders (pooled adjusted OR: 0.44, 95%CI: 0.35-0.56, P < 0.00001). Furthermore, rivaroxaban therapy was found to be associated with reduced risk of mild PTS (OR: 0.64, 95%CI: 0.50-0.82, P = 0.0005), moderate PTS (OR: 0.64, 95%CI: 0.45-0.91, P = 0.01), and severe PTS (OR: 0.52, 95%CI: 0.33-0.82, P = 0.005). There was also a similar trend towards reduced risk for venous ulcer, albeit not statistically significant (OR: 0.41, 95%CI: 0.15-1.08, P = 0.07).

Conclusion: In comparison to VKAs, the use of rivaroxaban for DVT treatment has the potential to reduce PTS events. However, well-designed studies with larger sample sizes are needed to corroborate these findings.

Keywords: Anticoagulants; Factor Xa inhibitors; Postthrombotic syndrome; Rivaroxaban; Warfarin.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Anticoagulants
  • Fibrinolytic Agents
  • Humans
  • Postthrombotic Syndrome* / drug therapy
  • Postthrombotic Syndrome* / etiology
  • Postthrombotic Syndrome* / prevention & control
  • Rivaroxaban* / adverse effects
  • Vitamins

Substances

  • Anticoagulants
  • Fibrinolytic Agents
  • Vitamins
  • Rivaroxaban