Journal Club Summary
Methodology Score: 4/5
Usefulness Score: 3.5/5
Castellucci LA, et al. JAMA. 2014 Sep 17;312(11):1122-35.
This network meta-analysis comparing the efficacy and safety outcomes associated with 8 anticoagulation options (unfractionated heparin, LMWH or fondaparinux in combination with Vitamin K, LMWH with dabigatran or edoxaban, rivaroxiban, apixaban and LMWH alone) found no statistically significant differences; however, a suggestion that UFH-Vit K is the least effective strategy and rivaroxiban and apixaban may be associated with the lowest bleeding risk. Overall, the group felt that the methodology was excellent and while some JC attendees are changing their practice, there was not overall consensus that this was yet indicated.
By: Dr. Amanda Collier
(Presented December 2014)
Epi Lesson: Network Meta-analysis
Network meta-analyses should not be viewed as the same as other meta-analyses. This specialized methodology is designed to answer complex management questions when there are multiple options possible. This is particularly helpful when a head-to-head RCT is not practical to conduct. The key requirement is that the studies being compared have at least one common or equivalent therapy among them.
By: Dr. Lisa Calder