Sex related differences in patients with acute venous thromboembolism treated with new oral anticoagulants. A meta-analysis of the interventional trials.

ABSTRACT

BACKGROUND: Gender differences have been reported in patients with acute VTE treated with antithrombotic drugs. OBJECTIVE: To address the relationship between gender and new oral anticoagulants (NOACs), we performed a meta-analysis to evaluate the incidence of recurrent VTE and major plus clinically relevant non-major bleedings in males and females, with acute VTE, treated with NOACs over the treatment period. DESIGN: Systematic review and meta-analysis of double blind randomized controlled trials (RCTs). DATA SOURCES MEDLINE, Cochrane Library of Clinical Trials (up to September 2015). STUDY SELECTION RCTs that compared the beneficial and harmful effects of NOAC drugs (apixaban, dabigatran, edoxaban and rivaroxaban). DATA EXTRACTION Three authors abstracted data. Study-specific risk ratios (RR) were combined using random-effects model. RESULTS: Nine studies including 16,372 patients were selected. No significant difference for the incidence of recurrent VTE was found between men and women. Compared to men, women had a higher incidence of major bleedings plus clinically relevant minor bleedings (5.3% and 7.9% respectively; RR 0.635; 95% CI 0.54-0.74; p<0.001). The subgroup analysis showed a significant gender difference in incidence of major bleedings and clinically relevant minor bleedings only for Edoxaban (RR 0.52; 95% CI 0.42-0.64; p<0.001). CONCLUSIONS: This meta-analysis showed, compared to men, a higher risk of bleeding in women with acute VTE treated with NOACs. Future trials should evaluate the effect of gender on bleeding in patients with acute VTE treated with NOACs.