Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is moderate or low to moderate where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for key outcomes.
Population: Adults with symptomatic, objectively verified proximal deep vein thrombosis (DVT) or pulmonary embolism (PE)
Intervention: Oral direct thrombin inhibitors or oral factor Xa inhibitors
Comparison: Conventional anticoagulation ᵃ
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Oral direct thrombin inhibitors versus conventional anticoagulation | ||
Recurrent PE (follow‐up: 6 months) | No statistically significant difference | Moderate |
Recurrent venous thromboembolism (VTE) (follow‐up: 6 months) | No statistically significant difference | Moderate |
DVT (follow‐up: 6 months) | No statistically significant difference | Moderate |
Adverse effects of treatment (major bleeding) (follow‐up: 6 months) | No statistically significant difference | Moderate |
All‐cause mortality, health‐related quality of life, incidence of chronic thromboembolic pulmonary hypertension | See note ᵇ | GRADE assessment not performed for these outcomes |
Oral factor Xa inhibitors versus conventional anticoagulation | ||
Recurrent PE (follow‐up: 0–12 months) | No statistically significant difference | Moderate |
Recurrent VTE (follow‐up: 0–12 months) | No statistically significant difference | Moderate |
DVT (follow‐up: 5 days–12 months) | No statistically significant difference | Moderate |
All‐cause mortality (follow‐up: 0–12 months) | No statistically significant difference | Moderate |
Adverse effects (major bleeding) (follow‐up: 0–12 months) | No statistically significant difference | Low |
Health‐related quality of life, incidence of chronic thromboembolic pulmonary hypertension | See note ᶜ | GRADE assessment not performed for these outcomes |
Note The Cochrane review which underpins this Cochrane Clinical Answer (CCA) noted that practical advantages of direct oral anticoagulants (DOACs), which include direct thrombin inhibitors (dabigatran) and factor Xa inhibitors (apixaban, edoxaban, rivaroxaban), over conventional anticoagulants include that they do not require routine blood tests and come in fixed doses. The Cochrane review also noted that additional research is required to evaluate the benefits and harms of individual DOACs versus one another especially in relation to bleeding risks in people with cancer or obesity. ᵃ Conventional anticoagulation was defined by the Cochrane review as 'other anticoagulation' (warfarin, low molecular weight heparin, unfractionated heparin) for a minimum of 3 months. Please see the CCA for more information. ᵇ None of the included studies reported all-cause mortality or quality of life and reviewers did not assess the incidence of chronic thromboembolic pulmonary hypertension. ᶜ None of the included studies reported quality of life and reviewers did not assess the incidence of chronic thromboembolic pulmonary hypertension.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- How does low‐molecular‐weight heparin (LMWH) compare with unfractionated heparin (UFH) for adults with an acute medical illness and reduced mobility?
- How do oral direct thrombin inhibitors (DTIs) and oral factor Xa inhibitors compare with conventional anticoagulation for the treatment of pulmonary embolism?
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