Treatment of venous thromboembolism in cancer patients: a systematic review and meta-analysis on the efficacy and safety of different direct oral anticoagulants (DOACs)

Song, Xiaojun; Liu, Zhili; Zeng, Rong; Shao, Jiang; Liu, Bao; Zheng, Yuehong; Liu, Changwei; Ye, Wei

doi:10.21037/atm-20-8156

Cited by 11 publications

(4 citation statements)

References 33 publications

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“…Our principal findings are consistent with previous meta-analyses which have pooled the same RCT data [ 18 , 19 ]. The recent Song et al meta-analysis [ 20 ], however, differed from our current meta-analysis in significant aspects. For instance, there was no stratification of the patient population according to cancer status, regardless of the fact that cancer status has a crucial influence on the risk for VTE.…”

Section: Discussioncontrasting

confidence: 66%

DOACs or VKAs or LMWH – What is the optimal regimen for cancer-associated venous thromboembolism? A systematic review and meta-analysis

Yamani

Unzek

Almas³

et al. 2022

Annals of Medicine &Amp; Surgery

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Section: Discussioncontrasting

confidence: 66%

DOACs or VKAs or LMWH – What is the optimal regimen for cancer-associated venous thromboembolism? A systematic review and meta-analysis

Yamani

Unzek

Almas³

et al. 2022

Annals of Medicine &Amp; Surgery

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“…Moreover, existing studies showed conflicting results on this issue. 27 28 In our study, when analyzing these results in detail for each DOAC, we found no significant difference in major bleeding among the drugs available in Korea. Several prospective studies are currently evaluating the bleeding complications of each DOAC in CT. Upcoming results may reveal a better treatment strategy.…”

Section: Discussionmentioning

confidence: 50%

Treatment and Bleeding Complications of Cancer-Associated Venous Thromboembolism: A Korean Population-Based Study

Kim

Lee

et al. 2022

Thromb Haemost

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Objectives: Recent studies have shown that direct oral anticoagulants (DOACs) are effective for cancer-associated venous thromboembolism (CAT). This study investigated the treatment pattern and the rate of bleeding complications in real-world practice in CAT patients. Patients/Methods: We used the Korean Health Insurance Review and Assessment service database (2014-2018). Among patients with venous thromboembolism, patients with concomitant malignancy diagnostic codes were categorized as CAT, while all others were categorized as non-CAT. Treatments were categorized as DOAC, parenteral anticoagulant (PAC), warfarin, and mixed anticoagulant. Results: We identified 27,205 CAT and 57,711 non-CAT patients. DOACs were the most frequently used anticoagulants. The proportion of patients treated with PAC was significantly higher in CAT than non-CAT patients. (35.7% vs. 19.5%) (P<0.01). In CAT, the cumulative incidence of any/major bleeding was significantly higher with DOAC (8.1%/3.9%) than PAC (7.5%/3.2%; P=0.04 and 0.01, respectively). However, there was no difference in major bleeding when compared with warfarin (P=0.11) or mixed anticoagulant (P=0.94). Overall, gastrointestinal (GI) cancer patients showed higher risks of bleeding. The cumulative incidence of major GI bleeding was higher with DOAC than PAC (4.9% vs. 3.0%; P<0.01), while there was no difference compared with warfarin (P=0.59) or mixed anticoagulant (P=0.80). Major bleeding with each DOAC showed no difference among entire CAT (P=0.94), GI cancer (P=0.27), and GU cancer (P=0.88) patients. Conclusions: DOACs have become the most prescribed anticoagulant in CAT. Bleeding was more prevalent with DOAC than PAC. The bleeding complications should be carefully monitored to ensure optimal treatment, especially with DOAC.

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“…Cancer patients are 4 to 7 times more likely to develop VTE, with it being the second cause of death among these patients [1,2]. The incidence of recurrent VTE is 9.6%, reaching 22.1% in the first 6 months after the initial diagnosis of cancer [3]. Anticoagulant therapy is recommended to prevent VTE in high-risk patients (KHORANA score >2) and to treat those who have already had a thrombotic event [4].…”

Section: Introductionmentioning

confidence: 99%

“…However, this therapy carries a significant risk of bleeding, the most serious adverse reaction. Lowmolecular-weight heparins (LMWHs) and direct oral anticoagulants (DOACs) are the most widely used anticoagulant treatments [3,5]. Dalteparin, an LMWH, is recommended in patients with cancer-related VTE, as it has been associated with a lower incidence of osteoporosis and heparin-induced thrombocytopenia [6].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Apixaban versus Dalteparin as a Treatment for Cancer-Associated Venous Thromboembolism: A Systematic Review and Meta-Analysis

Arce-Huamani,

Barboza,

Martínez-Herrera

et al. 2023

Medicina

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Background and Objectives: Venous thromboembolism (VTE) is common in cancer patients. Anticoagulant therapy with low-molecular-weight heparins (LMWHs) and direct oral anticoagulants (DOACs), such as dalteparin and apixaban, have demonstrated efficacy and safety. However, more comparative research of these drugs is still needed. This study aimed to synthesize evidence on the efficacy of apixaban compared to dalteparin in reducing recurrent VTE, major bleeding, and clinically relevant non-major bleeding associated with cancer. Materials and Methods: We systematically searched the PubMed, Scopus, Web of Science, Embase, Cochrane Library, and ClinicalTrials databases up to 5 January 2023, for randomized controlled trials comparing apixaban versus dalteparin as treatment for cancer-associated VTE. Five studies were included. Effects according to meta-analyses were reported as relative risks (RRs) and their 95% confidence intervals (CIs). Results: It was found that 33 of 734 (4.5%) patients treated with apixaban and 56 of 767 (7.3%) with dalteparin had recurrent VTE as the efficacy outcome (RR 0.49, 95% CI 0.15–1.58, I2 38%). Major bleeding occurred in 25 of 734 patients treated with apixaban (3.4%) and 27 of 767 with dalteparin (3.5%) (RR 1.29, 95% CI 0.31–5.27, I2 59%). Likewise, clinically relevant non-major bleeding occurred in 64 of 734 patients treated with apixaban (8.7%) and 46 of 767 (5.9%) with dalteparin (RR 1.52, 95% CI 1.05–2.19, I2 0%). Conclusions: Apixaban showed a lower risk of recurrent VTE than dalteparin in patients with cancer-associated VTE, but without statistical significance. No statistical significance was observed in clinically relevant major or non-major bleeding.

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Treatment of venous thromboembolism in cancer patients: a systematic review and meta-analysis on the efficacy and safety of different direct oral anticoagulants (DOACs)

Cited by 11 publications

References 33 publications

DOACs or VKAs or LMWH – What is the optimal regimen for cancer-associated venous thromboembolism? A systematic review and meta-analysis

DOACs or VKAs or LMWH – What is the optimal regimen for cancer-associated venous thromboembolism? A systematic review and meta-analysis

Treatment and Bleeding Complications of Cancer-Associated Venous Thromboembolism: A Korean Population-Based Study

Efficacy and Safety of Apixaban versus Dalteparin as a Treatment for Cancer-Associated Venous Thromboembolism: A Systematic Review and Meta-Analysis

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