Direct oral anticoagulant versus low-molecular-weight heparin for treatment of venous thromboembolism in cancer patients: An updated meta-analysis of randomized controlled trials

Haykal, Tarek; Zayed, Yazan; Deliwala, Smit; Kerbage, Josiane; Ponnapalli, Anoosha; Malladi, Srikanth; Goranta, Sowmya; Samji, Varun; Adam, Soheir

doi:10.1016/j.thromres.2020.06.025

Cited by 19 publications

(30 citation statements)

References 29 publications

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“…Though the risk of major bleeding was nonsignificantly higher, DOACs had a 6.6% significant absolute increase in the subgroup who had gastrointestinal cancer. 12 Broadly similar observations have been noted in other meta-analyses of the DOACs for the treatment of acute VTE associated with cancer. 13 The study by Ageno et al in this issue of Thrombosis and Haemostasis is a welcome addition to the body of evidence.…”

supporting

confidence: 75%

“…higher. Though the risk of major bleeding was non-significantly higher, DOACs had a 6.6% significant absolute increase in the subgroup who had gastrointestinal cancer (12).…”

mentioning

confidence: 82%

“…[8][9][10][11] A recent meta-analysis included four randomized trials (2,907 patients with cancer-related VTE) that compared apixaban (two trials), edoxaban (one trial), or rivaroxaban (one trial) with dalteparin. 12 Risk for recurrent VTE was 3.5% absolute points lower in patients treated with a DOAC, but clinically relevant nonmajor bleeding (CRNMB) was 4.7% higher. Though the risk of major bleeding was nonsignificantly higher, DOACs had a 6.6% significant absolute increase in the subgroup who had gastrointestinal cancer.…”

mentioning

confidence: 88%

“…Several trials have assessed the efficacy and safety of DOACs for patients with cancer-associated thrombosis (8)(9)(10)(11). A recent meta-analysis included 4 randomized trials (2,907 patients with cancer-related VTE) that compared apixaban (2 trials), edoxaban (1 trial) or rivaroxaban (1 trial) with dalteparin (12). Risk for recurrent VTE was 3.5% absolute points lower in patients treated with a DOAC, but clinically relevant nonmajor bleeding (CRNMB) was 4.7%…”

mentioning

confidence: 99%

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Safety of Apixaban for Cancer-Associated Thrombosis

Bikdeli

Jiménez

2021

Thromb Haemost

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supporting

confidence: 75%

“…higher. Though the risk of major bleeding was non-significantly higher, DOACs had a 6.6% significant absolute increase in the subgroup who had gastrointestinal cancer (12).…”

mentioning

confidence: 82%

mentioning

confidence: 88%

mentioning

confidence: 99%

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Safety of Apixaban for Cancer-Associated Thrombosis

Bikdeli

Jiménez

2021

Thromb Haemost

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“…Multi-center RCTs with large sample size are needed to further investigate the e cacy and safety of speci c DOAC. Third, the subgroups of different kinds of cancers were not analyzed, which may in uence the e cacy and safety of DOACs (31). Future studies should focus on the effects of different DOACs on speci c cancers so as to help clinicians better determine the treatment strategy for VTE in patients with different cancers.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Venous Thromboembolism in Cancer Patients: A Systemic Review and Meta-analysis on the Efficacy and Safety of Different DOACs

Song

Liu

Zeng

et al. 2020

Preprint

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Background: To evaluate the efficacy and safety of different direct oral anticoagulants (DOACs) compared with low molecular weight heparin (LMWHs) in the treatment of venous thromboembolism (VTE) in cancer patients.Methods: Literature was searched in databases including Cochrane Library, EMBASE (Ovid) and MEDLINE (Pubmed). Eligible studies were included and data were collected independently by two reviewers. We conducted a systemic review of the efficacy and safety of DOACs in the treatment of VTE in cancer patients. The odds ratios of different DOACs compared with LMWHs for VTE, DVT, PE recurrences, major bleeding and clinically relevant non-major bleeding (CRNMB) were calculated in meta-analyses and subgroup analyses.Results: A total of 18 articles were eligible for analyses, including 4 randomized controlled trials (RCTs) and 14 retrospective studies. Both RCTs and retrospective studies confirmed that DOACs decreased the risk of VTE recurrence (RCTs: OR, 0.60; 95%CI, 0.45-0.80; retrospective studies: OR, 0.73; 95%CI, 0.59-0.90) and DVT recurrence (RCTs: OR, 0.54; 95%CI, 0.36-0.80; retrospective studies: OR, 0.20; 95%CI, 0.06-0.63), but not PE recurrence or fatal PE in cancer patients. Subgroup analyses revealed an important role of rivaroxaban in decreasing recurrent VTE. Meanwhile, major bleeding events were not increased in the DOAC group, but the risk of CRNMBs were significantly elevated. Subgroup analyses confirmed the role of rivaroxaban in increasing the risk of major bleeding events and CRNMBs. Conclusions: Compared with LMWHs, DOACs, especially rivaroxaban, significantly reduced the risk of VTE and DVT, rather than PE, recurrence in patients with cancer. Although DOACs did not increase the major bleeding events in pooled analysis, rivaroxaban was showed an elevated risk of this adverse effect in subgroup analysis. In addition, the risk of CRNMB events was increased after the application of DOACs including rivaroxaban.

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