Comparative Efficacy of Direct Oral Anticoagulants and Low-Molecular-Weight Heparin in Cancer-Associated Thromboembolism: A Systematic Review and Meta-Analysis

Abstract

Patients diagnosed with cancer often experience an abnormal occurrence of venous thromboembolism (VTE) and its related complications. In order to evaluate the safety and effectiveness of both treatment approaches, we conducted a comprehensive systematic review and meta-analysis within the realm of cancer-associated thromboembolism. A thorough search was conducted across PubMed, the Cochrane Library, and Embase databases to find studies comparing direct oral anticoagulants (DOACs) with low molecular weight heparins (LMWHs) for the treatment of VTE in patients with malignancy. The analyses utilized the random-effects model. This meta-analysis included 11 studies. The results showed that DOACs were associated with a significantly reduced risk of VTE recurrence (RR: 0.67; 95% CI: 0.55, 0.81, p<0.0001; I2: 0%) and deep vein thrombosis (DVT) (RR: 0.63; 95% CI: 0.46, 0.86, p<0.0001; I2: 0%) compared to LMWHs. However, there was no significant difference in the risk of pulmonary embolism (PE) (RR: 0.76; 95% CI: 0.54, 1.06, p=0.11; I2: 11%) between the two groups. The use of DOACs was also associated with a nonsignificant increase in the risk of major bleeding events (RR: 1.

Insulin Resistance and Coronary Artery Disease: Untangling the Web of Endocrine-Cardiac Connections

“…Macrophages present in these sites secrete inflammatory mediators, which sustain a condition of persistent low-level inflammation. The defective adipocytes lead to the generation of FFAs, which worsens inflammation and insulin resistance in nearby tissues [10].…”

“…Hyperinsulinemia, a reaction to insulin resistance, increases the synthesis of molecules that promote the development of atherosclerosis, such as endothelin-1 and plasminogen activator inhibitor-1 (PAI-1). These chemicals facilitate the occurrence of inflammation, oxidative stress, and the multiplication of vascular smooth muscle cells, which are crucial mechanisms in the formation of atherosclerotic lesions [10]. Furthermore, insulin resistance leads to dyslipidemia, characterized by increased triglyceride levels and decreased high-density lipoprotein cholesterol (HDL-C) levels.…”

“…Furthermore, insulin resistance leads to dyslipidemia, characterized by increased triglyceride levels and decreased high-density lipoprotein cholesterol (HDL-C) levels. This dyslipidemic profile increases the entry of harmful low-density lipoprotein cholesterol (LDL-C) into the arterial wall, forming foam cells filled with lipids in the inner layer of the artery [10]. The fatty streaks that form indicate the initial phases of atherosclerosis, signifying the beginning of CAD development.…”

“…Insulin resistance exacerbates atherosclerosis by compromising the anti-inflammatory effects of insulin. Typically, insulin has antiinflammatory effects by preventing the production of adhesion molecules on the cells that line blood vessels and decreasing the movement of specific immune cells into the inner layer of arteries [10]. In insulinresistant conditions, the ability of these anti-inflammatory mechanisms to function appropriately is diminished, creating a pro-inflammatory milieu that promotes the development of atherosclerotic plaques.…”

Clinical Characteristics and Incidence of Hemorrhagic Complications in Patients Taking Factor Xa Inhibitors in Spain: A Long-Term Observational Study

“…In general, these studies have shown that DOACs could be a superior therapeutic option for managing cancer-associated thromboembolism compared to low-molecular-weight heparin. Despite these results, low-molecular-weight heparins, particularly enoxaparin, an anti-factor Xa, are still frequently used in Spain among patients with cancer [ 11 , 12 , 13 , 14 ].…”