antithrombotics

systematic review meta-analysis network meta-analysis

Select acute coronary syndromeacute myocardial infarctionatrial fibrillationheart failurepercutaneous coronary interventionperipheral vascular diseasespost acute coronary syndromes post myocardial infarctionpulmonary embolismstable anginastentsuperficial thrombophlebitisthrombosis preventionvenous thrombosis extented secondary preventionabdominal surgeryAll type of patientarthroscopyelective hip replacementelective major knee surgerygeneral surgerygynaecological surgeryhip Fractureuncoded clinical condition ***medical patientsMI patients undergoing primary PCIneurosurgeryorthopedic surgerypatients hospitalized for heart failurepatients with cancerPCI with stent placementprimary prevention of thromboembolic events--- uncoded (null)superficial thrombophlebitis of the legunstable anginaurologic surgery       6 months DAPTacetaminanti-agrégantantiagregantanticoagulantanticoagulants + antiplatelet agentsantiplateletantiplatelet drugsantivitamins Kaspirinbivalirudinclopidogrelcompetitive PAR-1 antagonistdefibrotidedesmindipyridamoldirect anti-IIadirect anti-Xadirect factor Xa inhibitorsdirect oral anticoagulantdirect thrombin inhibitordual antiplatelet therapyEnzyme therapyEssavenEtofenakExhirudextended anticoagulantextended LMWHextended prophylaxisExtended-duration prophylaxisFixed-dose LMWHfondaparinuxGP IIaIIIb inhibitorsGraduated compression stockings Heparansulphateheparinheparin SCheparin spraygelHigh-dose UFHhome treatmentidraparinuxindirect anti-XALMWHlong term LMWHLow molecular weight heparinNimesulideNOACNSAIDsonce daily LMWHoral anticoagulantoral direct thrombin inhibitororal factor Xa inhibitororal factor Xa inhibitorsoral platelet GP IIbIIIa receptor inhibitoroutpatient treatmentP2Y12 receptor antagonistPAR-1 inhibitorpentasccharideplatelet aggregation inhibitorsprolonged dual antiplatelet therapyprolonged oral VKAProphylactic LMWHProphylactic UFHrecombinant hirudinreversible ADP receptor antagonistreversible longlasting indirect inhibitor of activated factor Xselective PAR-1 thrombin receptor antagonistshort term LMWHshort term UFHsubcutaneous heparinsurgerysynthetic oligosaccharidesynthetic pentasaccharideTherapeutic LMWHthienopyridinethrombectomyticlopidineTopical methylthioadenosinetriple antiplateletUFHunfractionated heparinVasotoninVKAWeight-adjusted LMWH rosuvastatincandesartanLMWHabciximabacenocoumarolapixabanardeparinargatrobanaspirinatopaxarBemiparinbetrixaban bivalirudincangrelorCertoparincilostazolclopidogrelcoumadindabigatrandalteparindefibrotidedeltaparinDiclofenacdipyridamoledoxabanEfegatranelinogrelenoxaparineptifibatidefondaparinuxfraxiparinheparinhirudinidraparinuxinogatranlogiparinnadroparinNimesulideotamixabanphenindioneprasugrelreviparinrivaroxabansulfinpyrazonesuloctidilsulotrobanticagrelorticlopidinetinzaparintirofibantrapidiltriflusalUFHvorapaxarwarfarinximelagatran vs warfarinvs antithromboticsvs control or placebovs discontinuationvs heparin + anti Gp2b3avs no anticoagulantvs pentascharidevs placebovs placebo and controlvs placebo or controlvs placebo or no treatmentvs anticoagulantvs anticoagulant + antiplateletvs antiplateletvs antiplatelet drugsvs aspirinvs clopidogrelvs Danaparoidvs Dextranvs DHEvs eptifibatide + heparinvs fondaparinuxvs heparinvs heparin+aGP2b3avs heparin/VKAvs inpatient treatmentvs intermittent pneumatic compressionvs LMWHvs Low molecular weight heparinvs oral anticoagulantvs short antiplatelet drugvs standard clopidogrelvs twice daily LMWHvs UFHvs Unfractionated heparinvs unfractioned heparin       DOAC without heparinheparin - DOAC

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Group by Group by... nothing pathology treatment patient comparator classe classe comparator mechanism clinical condition MA  in first nothing pathology treatment patient comparator classe classe comparator mechanism clinical condition  in second nothing pathology treatment patient comparator classe classe comparator mechanism clinical condition  in third	Description Synopsis Comparison Treatments Patients Characteristics Method Risk of bias References None Tools Indexation					Results Global trial result Main results All results All result tag NCT results	Major bleeding (523)All cause death (492)Bleeding (253)Deep vein thrombosis (251)non-fatal pulmonary embolism (221)fatal pulmonary embolism (197)Symptomatic pulmonary embolism (160)asymptomatic DVT (158)wound haematoma / infection (134)Symptomatic venous thromboembolism (DVT, PE) (122)Fatal bleeding (120)myocardial infarction (fatal and non fatal) (112)proximal DVT (99)stroke (fatal and non fatal) (91)Minor bleeding (87)Cardiovascular death (82)Recurrent thromboembolic event (78)thrombo-embolic event (cerebral or systemic) (78)ischemic stroke (74)major or clinically relevant non-major bleeding (70)total VTE and all-cause mortality (68)Symptomatic deep-vein thrombosis (68)TE event or ischemic stroke or systemic embolism (67)transfusion (65)MACE (61)Haemmorhagic stroke (59)cardiovascular events (58)distal DVT (56)Fatal stroke (55)major VTE (fatal and non fatal DVT,PE) (54)Coronary event (52)systemic thrombo-embolic complication (50)Venous thromboembolism (46)VTE (41)myocardial infarction or death (40)non pulmonary embolism death (39)Non fatal stroke (38)Revascularization (36)Short term haemorrhage (34)Vascular death (32)Non fatal MI (30)Non vascular death (30)recurrent angina (28)symptomatic venous thromboembolism at the end of treatment (26)Thrombus extension (20)intracranial hemorrhage (19)pulmonary embolism (symptomatic and asymptomatic) (19)stent thrombosis (17)all cause death, non-fatal MI, thrombo-embolic stroke (15)any bleedings (15)reinfarction (15)In-hospital death (15)VTE during active anticoagulant treatment (13)Amputation (12)death at 30 days (11)death, MI, unplanned revascularization (11)Extracranial hemorrhage (10)reinfarction at 30 days (10)Vascular events (10)Treatment related complication (10)death at 30 days (9)myocardial infarction at 30 days (9)Unplanned revascularisation for ischaemia (9)Gastrointestinal major bleeding (8)Long term death (7)VTE during follow-up after active anticoagulant treatment (7)recurrent VTE during treatment (7)Death related to venous thromboembolism (7)death, myocardial infarction, or recurrent at 30 days (6)fatal bleeding (6)death at 3 months (6)Thrombocytopenia (6)puylmonary embolism (6)Lifethreatening major bleeding (5)symptomatic pulmonary embolism (5)major bleeding TIMI (5)death, myocardial infarction, or recurrent at 14 days (4)cardiac event (fatal and non fatal ) (4)major or minor bleeding (4)net benefit (4)All-cause hospitalisation (4)Venous thromboembolism or death (4)ischemic events + bleeding (4)stroke or TIA (4)all cause death, MI, stroke (3)all cause death, MI, thrombo-embolic stroke (3)exacerbation of heart failure (3)proximal deep-vein thrombosis (3)recurrent DVT (3)recurrent VTE (3)Cardiovascular death/MI/stent thrombosis (3)GUSTO severe/moderate bleeding (3)Drop in platelet count of 50% (2)refractory ischemia (2)Coronary death (2)Deaths or MI (2)Fatal MI (2)Non-lifethreatening major bleeding (2)major bleeding not related to CABG (2)1 year death from any cause (2)1 year MI (2)1 year unplanned revascularization for ischemia (2)1 year composite ischemia (2)TIMI minor bleeding (2)Infection (2)hypertransaminasemia (1)recurrent symptomatic venous thromboembolism and death at the end of treatment (1)Recurrent DVT/DVT extension (symptomatic) (1)Urgent target-vessel revascularization (1)Stent thrombosis (any, end of follow up) (1)Major or minor TIMI bleeding (1) Options Numeric bar chart forest plot medians
Trial	Studied trt	Control trt	patients	tags	ROB	Trial result	Major bleeding	All cause death
acute coronary syndrome
apixaban
APPRAISE-1 (10mg od), 2009      NCT	apixaban	placebo			Low risk of bias	negative
APPRAISE-1 (2.5 mg bid), 2009      NCT	apixaban	placebo			Low risk of bias	negative
APPRAISE 2, 2011      NCT	apixaban	placebo			Low risk of bias	negative
argatroban
ARGAMI-2, 1998	Argatroban	heparin				-
aspirin
ATACS-pilot, 1990	aspirin	control				negative
VA-pilot	aspirin	placebo				negative
VA-main, 1983	aspirin	placebo			Low risk of bias	suggesting
RISC, 1990	aspirin	placebo			Low risk of bias	suggesting
ALDUSA-pilot	aspirin	placebo				negative
Théroux, 1988	aspirin	placebo			Low risk of bias	suggesting
Canadian (Aspirin vs PBO), 1985	aspirin	placebo			Low risk of bias	-
Canadian (Aspirin + sulfinpyrazone), 1985	aspirin + sulfinpyrazone	placebo			Low risk of bias	negative
atopaxar
LANCELOT ACS	atopaxar	placebo			Exploratory	-
J-LANCELOT, 2010	atopaxar	placebo			Exploratory	-
bivalirudin
ACUITY (biva alone vs hep+aGP2b3a), 2006      NCT	bivalirudin	heparin + GP2b3a inhibitors			Low risk of bias	suggesting
ACUITY (biva+aGP2b3a vs hep+aGP2b3a), 2006    NCT	bivalirudin + GP2b3a inhibitors	heparin + GP2b3a inhibitors			Low risk of bias	negative
PROTECT-TIMI 30, 2006      NCT	bivalirudin	eptifibatide + heparin			Exploratory	-
HERO, 1997	bivalirudin	heparin			Low risk of bias	suggesting
BAT (Bittl), 1995	bivalirudin	heparin			Low risk of bias	suggesting
ACUITY (sub groups PCI, bivalirudin alone) importé, 2007	bivalirudin	heparin + GP2b3a inhibitors				suggesting
ACUITY (sub groups PCI, bivalirudin +aGP2b3a) importé, 2007	bivalirudin + GP2b3a inhibitors	heparin + GP2b3a inhibitors				negative
clopidogrel
CURE (PCI sub study), 2001	clopidogrel	placebo			Low risk of bias	-
CURE, 2001	clopidogrel + aspirin	aspirin			Low risk of bias	suggesting
CURRENT OASIS 7 (clopidogrel), 2010    NCT	clopidogrel high-dose regimen	clopidogrel standard-dose			Low risk of bias	negative
coumadin
ASPECT-2 (coumadin+asp vs asp), 2002	coumadin	control (on top of aspirin)				suggesting
ASPECT-2 (coumadin vs aspirin), 2002	coumadin	aspirin				suggesting
dalteparin
FRISC (long term), 1996	dalteparin	placebo (on top of aspirin)			Low risk of bias	suggesting
FRIC prolonged treatment phase (LWMH vs PBO), 1997	dalteparin	placebo (on top of aspirin)			Low risk of bias	negative
FRISC (short term), 1996	dalteparin	placebo (on top of aspirin)			Low risk of bias	-
FRIC (acute phase LMWH vs UFH), 1997	dalteparin	UFH (on top of aspirin)			Exploratory	negative
dipyridamol
Prandoni, 1991	aspirin + dipyridamol	placebo			Low risk of bias	negative
Efegatran
Klootwijk, 1999	Efegatran	heparin			Exploratory	-
enoxaparin
RESCUE    NCT	enoxaparin	unfractionated heparin				-
EVET, 2005	enoxaparin	tinzaparin				suggesting
ESSENCE, 1997	enoxaparin	UFH (on top of aspirin)			Low risk of bias	suggesting
TIMI 11 B (short term), 1998	enoxaparin	UFH (on top of aspirin)			Low risk of bias	suggesting
SYNERGY, 2005          NCT	enoxaparin	UFH (on top of aspirin)				negative
INTERACT, 2006	enoxaparin	UFH (on top of aspirin)				suggesting
TIMI 11 B (long term), 1998	enoxaparin	UFH (on top of aspirin)			Low risk of bias	negative
fondaparinux
PENTUA, 2004	fondaparinux	enoxaparin				-
OASIS 5, 2006      NCT	fondaparinux	enoxaparin			Low risk of bias	-
hirudin
HIT-4, 1999	Hirudin	heparin			Low risk of bias	-
TIMI 9B, 1996	Hirudin	heparin			Risk of bias	-
GUSTO IIB, 1996	Hirudin	heparin			Risk of bias	-
OASIS pilot, 1997	Hirudin	heparin			Exploratory	-
HELVETICA (Serruys), 1995	Hirudin	heparin			Low risk of bias	-
OASIS 2, 1999	Hirudin	heparin			Low risk of bias	-
OASIS, 1997	Hirudin	heparin			Risk of bias	-
inogatran
TRIM, 1997	Inogatran	heparin			Low risk of bias	-
nadroparin
FRAXIS (6days), 1998	nadroparin	UFH (on top of aspirin)			Low risk of bias	negative
FRAXIS (14 days), 1998	nadroparin	UFH (on top of aspirin)			Low risk of bias	negative
otamixaban
SEPIA-ACS1 TIMI 42, 2009    NCT	otamixaban	unfractionated heparin			Low risk of bias	suggesting
prasugrel
TRILOGY ACS (overall population), 2012        NCT	prasugrel	clopidogrel			Low risk of bias	negative
TRITON-TIMI 38, 2007      NCT	prasugrel	clopidogrel			Low risk of bias	suggesting
rivaroxaban
ATLAS ACS 2 - TIMI 51 (2.5mg), 2011      NCT	rivaroxaban 2.5mg	placebo			Low risk of bias	suggesting
ATLAS ACS 2 - TIMI 51 (5mg), 2011      NCT	rivaroxaban 5mg	placebo				suggesting
sulfinpyrazone
Canadian (sulfinpyrazone alone), 1985	sulfinpyrazone	placebo			Low risk of bias	-
ticagrelor
PLATO, 2009      NCT	ticagrelor	clopidogrel			Low risk of bias	suggesting
DISPERSE-2 (90mg), 2007	ticagrelor	clopidogrel			Low risk of bias	negative
ticlopidine
STAI, 1990	ticlopidine	control				suggesting
Florida UA	ticlopidine	placebo				negative
trapidil
Modena	trapidil	placebo				suggesting
triflusal
TIM, 2000	triflusal	aspirin			Low risk of bias	-
Plaza, 1993	triflusal	placebo			Low risk of bias	suggesting
UFH
Holdright, 1994	UFH	control (on top of aspirin)				negative
RISC (heparin+aspirin vs ASP), 1990	UFH	control (on top of aspirin)				negative
Theroux (heparin+ASP vs ASP), 1988	UFH	control (on top of aspirin)			Low risk of bias	suggesting
ATACS (Cohen), 1994	UFH, warfarin	control (on top of aspirin)				negative
Cohen (ATACS pilot) (heparin+aspirin vs asp), 1990	UFH, warfarin	control (on top of aspirin)				negative
Theroux (heparin vs PBO), 1988	UFH	placebo			Low risk of bias	suggesting
RISC (heparin vs PBO), 1990	UFH	placebo				negative
Theroux (heparin+aspirin vs PBO), 1988	UFH + aspirin	placebo			Low risk of bias	suggesting
RISC (ASP+ heparin vs PBO), 1990	UFH + aspirin	placebo				suggesting
Gurfinkel (UFH+aspririn vs aspirin), 1995	UFH	placebo (on top of aspirin)			Low risk of bias	negative
Cohen (ATACS pilot) (heparin vs asp), 1990	UFH, warfarin	aspirin				negative
vorapaxar
TRACER, 2011      NCT	vorapaxar	placebo (on top standard therapy)			Low risk of bias	-
warfarin
ATACS (pilot study) (warfarin vs control), 1990	warfarin	control (on top of aspirin)				negative
ATACS, 1994	warfarin	control (on top of aspirin)				negative
CARS, 1997	warfarin	control (on top of aspirin)				negative
OASIS Pilot (phase 1), 1998	warfarin	control (on top of aspirin)				negative
OASIS Pilot (phase 2), 1998	warfarin	control (on top of aspirin)				negative
OASIS-2 Warfarin Substudy, 2001	warfarin	control (on top of aspirin)				negative
APRICOT-2, 2002	warfarin	control (on top of aspirin)				negative
CHAMP, 2002	warfarin	control (on top of aspirin)				negative
WARIS, 2002	warfarin	control (on top of aspirin)				suggesting
LoWASA, 2004	warfarin	control (on top of aspirin)				negative
Zibaeenezhad, 2004	warfarin	control (on top of aspirin)				negative
Williams, 1997	warfarin	placebo (on top of aspirin)			Low risk of bias	negative
Huyhn, 2001	warfarin	placebo (on top of aspirin)			Low risk of bias	negative
ATACS (pilot study) warfarin vs aspirin, 1990	warfarin	aspirin				negative
ximelagatran
ESTEEM, 2003	ximelagatran	placebo			Exploratory	-
acute myocardial infarction
argatroban
ARGAMI-2, 1998	Argatroban	heparin				-
bivalirudin
HERO, 1997	bivalirudin	heparin			Low risk of bias	suggesting
coumadin
ASPECT-2 (coumadin+ASA vs ASA), 2002	coumadin	control (on top of aspirin)				negative
ASPECT, 1994	coumadin	placebo			Low risk of bias	suggesting
ASPECT-2 (coumadin alone), 2002	coumadin	aspirin				suggesting
dalteparin
FRAMI, 1997	Dalteparin	placebo				-
BIOMACS II, 1999	Dalteparin	placebo			Low risk of bias	-
ASSENT Plus, 2003	Dalteparin	UFH				negative
enoxaparin
AMI-SK, 2002	Enoxaparin	placebo			Low risk of bias	-
ASSENT 3, 2001	Enoxaparin	UFH				suggesting
HART II, 2001	Enoxaparin	UFH				negative
Baird, 2002	Enoxaparin	UFH				negative
ENTIRE-TIMI 2, 2002	Enoxaparin	UFH				suggesting
ASSENT 3 Plus, 2003	Enoxaparin	UFH				negative
fondaparinux
MICHELANGELO OASIS-6, 2006      NCT	fondaparinux	placebo			Low risk of bias	suggesting
hirudin
HIT-4, 1999	Hirudin	heparin			Low risk of bias	-
TIMI 9B, 1996	Hirudin	heparin			Risk of bias	-
reviparin
CREATE, 2005	Reviparin	placebo			Low risk of bias	-
UFH
ISIS-2 Pilot, 1987	UFH	no heparin				negative
DUCCS, 1994	UFH	no heparin				negative
ECSG, 1992	UFH	placebo			Low risk of bias	negative
OSIRIS, 1992	UFH	placebo			Low risk of bias	negative
warfarin
APRICOT-2, 2002	warfarin	control (on top of aspirin)				suggesting
Zibaeenezhad, 2004	warfarin	control (on top of aspirin)				negative
WARIS, 1999	warfarin	control (on top of aspirin)			Low risk of bias	-
CHAMP, 2002	warfarin	control (on top of aspirin)				negative