Abstract 14870: Meta-Analysis of the Efficacy, Safety and Cost-Benefit of Direct Oral Anticoagulation for Extended Venous Thromboembolism Prophylaxis in Medically Ill Patients Post-Hospitalization

Medically ill patients remain at risk of venous thromboembolism (VTE) for up to 6 weeks after hospital discharge due to factors such as immobilization and inflammation. We conducted a meta-analysis and systematic review of Phase III randomized controlled trials comparing extended use of direct oral anticoagulation (DOAC) post-discharge for VTE prophylaxis with placebo (n=4). We determined the risk, benefit and cost-benefit of each. The primary efficacy outcome (composite of VTE and mortality) occurred in 373/13099 patients in the DOAC group (2.9%) and 477/13309 patients in the placebo group (3.6%) with an OR 0.79 (95% CI0.69-0.91). The secondary efficacy outcome (non-fatal symptomatic VTE) occurred in 75/15573 patients in the DOAC group (0.48%) and 120/15599 in the placebo group (0.77%) with an OR 0.62 (95% CI0.47-0.83). The primary safety outcome (major bleeding) occurred in 90/15474 patients in the DOAC group (0.58%) and in 47/15418 patients in the placebo group (0.3%) with an OR 1.92 (95% CI1.35-2.73). The secondary safety (clinically relevant non-major bleeding) outcome occurred in 333/15474 patients in the DOAC group (2.2%) and 191/15418 patients in the placebo group (1.2%) with an OR 1.75 (95% CI1.46-2.1). The extended use of VTE prophylaxis post-discharge results in decreased VTE events but increased bleeding risk. When extrapolated nationally, this reduced VTE fatality by 5,658 patients but increased bleeding fatality by 1,838. Our cost-effective analysis of extended DOAC use versus placebo showed superiority of the DOAC group. In conclusion, given the mortality benefit and cost-effectiveness, extended thromboprophylaxis would be a beneficial strategy.