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Antiplatelet agents as a complement to current treatment for deep vein thrombosis
Antiplatelet agents as a complement to current treatment for deep vein thrombosis
PEARLS No.
706
Clinical question
How effective are antiplatelet agents in addition to current best medical practice (BMP) compared with current BMP (with or without placebo) for the treatment of deep vein thrombosis (DVT)?
Bottom line
Two groups were studied: patients with acute DVT (treatment started up to 21 days after symptoms) and patients with chronic DVT (treatment started after 21 days of symptoms).
In chronic DVT settings, following the standard initial treatment with anticoagulants, low‐certainty evidence (4 randomised controlled trials, 901 participants) suggests that antiplatelet agents in addition to BMP, compared with BMP plus placebo, may reduce the risk of recurrent venous thromboembolism (VTE; number needed to treat to benefit = 14).
Moderate‐certainty evidence shows no clear difference in adverse events, major bleeding, all-cause mortality or pulmonary embolism (PE) in the same setting.
In acute and chronic DVT settings, following the standard initial treatment with anticoagulants, no conclusions could be drawn for antiplatelet agents in addition to BMP, compared with BMP alone (without placebo control), due to the evidence being of very-low certainty.
No eligible studies compared antiplatelet agents plus BMP versus BMP plus placebo for acute DVT.
Caveat
Some of the included studies presented a high risk of bias and so reduced the level of evidence presented. The short length of follow‐up (3 to 37 months) limited analysis for the long‐term time point and impacted data for chronic complications of DVT, such as post‐thrombotic syndrome.
All included studies were conducted and published more than 10 years ago (from 1978 to 2012). Since then, there have been some changes in what is considered BMP for the treatment of DVT episodes.
Context
VTE is the third most common cardiovascular disease in the world and is a growing public health problem, largely due to an ageing population. Platelets are the principal effector cells for haemostasis, coagulation and thrombosis that are unique to mammals, and are therefore deeply related to thrombus formation in DVT. Because antiplatelet agents act in the Virchow triad as inhibitors of clot formation, they may be a complement to the current treatment for DVT
Cochrane Systematic Review
Flumignan CDQ, et al. Antiplatelet agents for the treatment of deep venous thrombosis. Cochrane Database Syst Rev 2022;7:CD012369. This review contains 6 trials with a total of 1625 participants.
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