SynthesisClinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
Reduced Versus Full Lead-In Apixaban or Rivaroxaban in Acute Venous Thromboembolism: A Systematic Review.
Synthesis in Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. 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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Abstract
BackgroundDirect oral anticoagulants (DOACs) are recommended as first-line treatment for acute venous thromboembolism (VTE). The recommended regimen of apixaban and rivaroxaban requires a higher-intensity lead-in phase. However, clinicians may use reduced lead-in strategies due to concerns regarding bleeding risk, planned procedures, or prior parenteral anticoagulation. Recent evidence indicates that reduced lead-in dosing may provide comparable clinical outcomes compared to the recommended full lead-in dosing.MethodsIn this study, recent observational studies comparing reduced versus full lead-in apixaban or rivaroxaban therapy in acute VTE were systematically synthesized. Eligible studies included those involving adults treated with apixaban or rivaroxaban in which the lead-in duration was compared. Outcomes assessed included recurrent VTE, bleeding, and mortality.ResultsNine studies were included in this systematic review; reduced lead-in therapy did not increase VTE recurrence compared with full lead-in regimens. In addition, in these studies, no significant difference was found in major bleeding, clinically relevant non-major bleeding, and mortality across all lead-in strategies.ConclusionEvidence demonstrates that reduced lead-in therapy may be both safe and effective in selected patients, particularly those previously treated with therapeutic parenteral anticoagulation. However, current evidence remains observational and heterogeneous. A target trial emulation is required to define optimal lead-in duration and guide patient-specific dosing strategies.
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