SynthesisFrontiers in pharmacology2025
Full-dose versus reduced-dose comparison of direct oral anticoagulants for extended treatment of venous thromboembolism: a systematic review and meta-analysis of randomized controlled trials.
Synthesis in Frontiers in pharmacology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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7 authors.
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Abstract
Background: For patients requiring extended anticoagulation therapy, clinicians often prescribe reduced-dose direct oral anticoagulants (DOACs) rather than full-dose, which may be related to concerns about the higher bleeding risk associated with full-dose DOACs, despite potentially better efficacy in preventing VTE recurrence. This meta-analysis aims to evaluate the net clinical benefit of reduced-dose DOACs versus full-dose DOACs in extended anticoagulation therapy. Methods: This study has been registered in the International Prospective Register of Systematic Reviews (PROSPERO identifier: CRD420251089110). A systematic search was conducted in the PubMed, Embase, and Web of Science databases from their inception to 30 June 2025. Data extraction was done independently and in duplicate. A random-effects meta-analysis model was used to report the pooled treatment effects and 95% confidence intervals. Results: A total of 5 randomized clinical trials were included (8,781 cases). Compared with full-dose DOAC, reduced-dose DOAC did not significantly increase the risk of recurrent VTE or death [(RR, 0.94 (95% CI, 0.68-1.29)), (RR, 0.84 (95% CI, 0.65-1.09))], but significantly reduced the risk of major bleeding/CRNMB (RR, 0.71 (95% CI, 0.61-0.82)). In the analysis of DOAC drugs, the prospective estimates for recurrent VTE were as follows: apixaban, RR, 0.93 (95% CI, 0.63-1.37); rivaroxaban, RR 0.96 (95% CI, 0.54-1.69). The prospective estimates for major bleeding/CRNMB were as follows: apixaban, RR, 0.74 (95% CI, 0.63-0.89); rivaroxaban, RR, 0.63 (95% CI, 0.48-0.84). Most findings were consistent within subgroups. Conclusion: Reduced-dose DOACs were associated with a significant decrease in the risk of major bleeding/CRNMB compared with full-dose DOACs, but were not associated with a significant increase in the risk of recurrent VTE. These findings support the net clinical benefit of reduced-dose DOACs compared with full-dose DOACs and reinforce adherence with current VTE guidelines. Systematic Review Registration: Identifier CRD420251089110.
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