Non-vitamin K oral anticoagulants in patients with pulmonary embolism: a systematic review and meta-analysis of the literature

Limited information exists on the safety and efficacy of non-vitamin K oral anticoagulants (NOACs) in patients with pulmonary embolism (PE). The aim of this study is to evaluate the difference in the safety and efficacy of the NOACs in comparison to the standard treatment in patients presenting with deep vein thrombosis (DVT) and with PE using data from randomized controlled trials. MEDLINE and EMBASE databases were searched. Differences in the efficacy (recurrent VTE or death-related VTE) and in the safety (major bleeding) outcome were expressed as risk ratio (RR) with 95 % confidence intervals (95 % CI). Heterogeneity among the studies was assessed. Six studies (27,023 patients) were included. NOACs appeared to have a similar efficacy and safety compared to VKAs in patients presenting with PE and with DVT with a non-significant heterogeneity between the groups (efficacy: RR 0.90, 95 % CI 0.72, 1.13 in PE patients and 0.93, 95 % CI 0.75, 1.16 in DVT patients; χ2 0.04, p = 0.84; safety: RR 0.49, 95 % CI 0.26, 0.95 in PE patients and 0.74 95 % CI 0.51, 1.06 in DVT; χ2 1.10, p = 0.29). Our results suggest that the efficacy and safety of the NOACs compared to VKAs is similar between patients with PE and DVT.