Comparison of All-Cause Mortality Following VTE Treatment Between Propensity Score-Adjusted Observational Studies and Matched Randomized Controlled Trials Meta-Epidemiologic Study
Por:
Coscia, C, Jaureguizar, A, Quezada, CA, Muriel, A, Monreal, M, Villen, T, Barbero, E, Chiluiza, D, Yusen, RD and Jimenez, D
Publicada:
1 abr 2019
Ahead of Print:
25 oct 2018
Resumen:
BACKGROUND: It is unknown whether propensity score-adjusted observational studies produce results comparable to those of randomized controlled trials (RCTs) that address similar VTE treatment issues.
METHODS: The PubMed and Web of Science databases were systematically searched for propensity score-adjusted observational studies, RCTs, and meta-analyses of RCTs that estimated all-cause mortality following VTE treatment. After identifying distinct clinical treatment issues evaluated in the eligible observational studies, a standardized algorithm was used to identify and match at least one RCT or RCT meta-analysis publication for paired study design analyses. Meta-analyses were used to summarize groups of studies. Treatment efficacy statistics (relative ORs) were compared between the paired observational and RCT studies, and the summary relative ORs for all study design pairs were also calculated.
RESULTS: The observational and RCT study pairs assessed seven clinical treatment issues. Overall, the observational study-RCT pairs did not exhibit significantly different mortality estimates (summary relative OR, 0.89; 95% CI, 0.32-1.46; I-2 = 23%). However, two of the seven treatment issue study pairs (thrombolysis vs anticoagulation for pulmonary embolism; once- vs twice-daily enoxaparin for VTE) exhibited a significantly different treatment effect direction, and there was a substantial (nonsignificant) difference in the magnitude of the effect in another two of the study pairs (rivaroxaban vs vitamin K antagonists for VTE; home treatment vs hospitalization for DVT).
CONCLUSIONS: This systematic comparison across seven VTE treatment topics suggests that propensity score-adjusted observational studies and RCTs often exhibit similar all-cause mortality, although differences in the direction or the magnitude of estimated treatment effects may occasionally occur.
Filiaciones:
Coscia, C:
Ramon & Cajal Hosp, Biostat Dept, Madrid 28034, Spain
IRYCIS, CIBERESP, Madrid, Spain
Jaureguizar, A:
Univ Alcala IRYCIS, Med Dept, Hosp Ramon y Cajal, Resp Dept, Madrid, Spain
Quezada, CA:
Univ Alcala IRYCIS, Med Dept, Hosp Ramon y Cajal, Resp Dept, Madrid, Spain
Muriel, A:
Ramon & Cajal Hosp, Biostat Dept, Madrid 28034, Spain
IRYCIS, CIBERESP, Madrid, Spain
:
Hosp Badalona Germans Trias & Pujol, Dept Internal Med, Barcelona, Spain
Univ Catolica Murcia, Murcia, Spain
Villen, T:
Hosp Univ La Paz, Emergency Dept, Madrid 3, Spain
Barbero, E:
Univ Alcala IRYCIS, Med Dept, Hosp Ramon y Cajal, Resp Dept, Madrid, Spain
Chiluiza, D:
Univ Alcala IRYCIS, Med Dept, Hosp Ramon y Cajal, Resp Dept, Madrid, Spain
Yusen, RD:
Washington Univ, Sch Med, Div Pulm & Crit Care Med, St Louis, MO USA
Washington Univ, Sch Med, Div Gen Med Sci, St Louis, MO USA
Jimenez, D:
Univ Alcala IRYCIS, Med Dept, Hosp Ramon y Cajal, Resp Dept, Madrid, Spain
Green Published
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