Apixaban for the prevention of venous thromboembolism in people ...

Appendix 1B: Review of search strategies for Apixaban studies
Clinical effectiveness
Limitations
The ERG questioned the use of the term Arthroscopy rather than Arthroplasty in the searches
Medline, Cochrane and Cinahl databases. The Manufacturer reran these searches with the
additional term, but the ERG noted a few remaining weaknesses with this facet, including missing
truncation and synonyms such as replac$ or arthroplast$ or prosthe$ or surgery or surgical or
implant$ (see Appendix 1A).
The manufacturer stated in their response that the term arthroscopy was the relevant Mesh term to
use for those databases. Medline and Cochrane do contain the Mesh terms “Arthroplasty,
replacement, knee” and “Arthroplasty, replacement, hip” and the ERG notes that these were used
by the manufacturer in the Cost Effectiveness searches. 11
Neither the Apixaban synonym “Eliquis” nor the CAS registry number were searched, although
an additional search by the ERG showed that this made no change to the results (Appendix 1A).
Limited use of truncation. Examples:
i. Line #91 from Medline search, should use replac* rather than replacement to pick up
replace, replaced, replacing, replacement and replacements.
There were a number of redundant terms in the strategies. Examples:
i. Line #4 from the Medline search, “exp Thrombophlebitis/” is redundant due to the
previous line #3, “exp Venous Thrombosis/”.
Although start dates and search dates were reported there was no Issue given for the Cochrane
search.
Indirect and mixed treatment comparisons
Searches were carried out on all NICE required databases and used the same strategies as 9.2 of the
Industry submission. As well as the previous limitations the ERG also noted:
There were a number of redundant terms in the strategies. Examples:
ii. Line #4 from the Medline search, “exp Thrombophlebitis/” is redundant due to the
previous line #3, “exp Venous Thrombosis/”.
iii. Line #18 from the Embase search, “exp Dalteparin/” is redundant due to line #17, “exp
low molecular weight heparin/”.
Adverse events (comparators)
In utilizing the same searches as with Clinical Effectiveness and Mixed Treatment Comparators
the search strategies in this section carried the same problems as the previous sections. Given the
CRD advice on not using RCT filters in these cases, 12 the ERG would recommend removing the
RCT filter on Lines #27-86 (Medline Search 9.2.4 of the Industry submission) and replace them
with a suitable adverse events filter, a number of which can be found in the ISSG Search Filters
Resource. 68
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