Direct Oral Anticoagulants for the Treatment of Acute Venous Thromboembolism Associated with Cancer: A Systematic Review and Meta-Analysis.

Abstract

BACKGROUND:

 International guidelines have endorsed the use of edoxaban or rivaroxaban as an alternative to low-molecular-weight heparin (LMWH) for the treatment of acute venous thromboembolism (VTE) in cancer patients. Recently, a large randomized controlled trial of apixaban versus dalteparin in patients with cancer was completed. We performed an updated meta-analysis to assess the efficacy and safety of direct oral anticoagulants (DOACs) versus LMWH in patients with cancer-associated VTE.

METHODS:

 MEDLINE, EMBASE, and CENTRAL (Cochrane Controlled Trials Registry) were systematically searched up to March 30, 2020 for randomized controlled trials comparing DOACs versus LMWH for the treatment of VTE in patients with cancer. The two coprimary outcomes were recurrent VTE and major bleeding at 6 months. Data were pooled by the Mantel-Haenszel method and compared by relative risk ratios (RRs) and 95% confidence intervals (CIs).

RESULTS:

 Four randomized controlled studies (2,894 patients) comparing apixaban, edoxaban, or rivaroxaban with dalteparin were included in the meta-analysis. Recurrent VTE occurred in 75 of 1,446 patients (5.2%) treated with oral factor Xa inhibitors and in 119 of 1,448 patients (8.2%) treated with LMWH (RR 0.62; 95% CI 0.43-0.91; I 2, 30%). Major bleeding occurred in 62 (4.3%) and 48 (3.3%) patients receiving oral factor Xa inhibitors or LMWH, respectively (RR 1.31; 95% CI 0.83-2.08; I 2, 23%).

CONCLUSION:

 In patients with cancer-associated VTE, oral factor Xa inhibitors reduced the risk of recurrent VTE without a significantly higher likelihood of major bleeding at 6 months compared with LMWH.

• Authors: Michela Giustozzi, Giancarlo Agnelli, Jorge Del Toro-Cervera, Frederikus A Klok, Rachel P Rosovsky, Anne-Céline Martin, Joerg Herold, Inna Tzoran, Sebastian Szmit, Laurent Bertoletti, Cecilia Becattini, Menno V Huisman
• Journal: Thrombosis and haemostasis (Thromb Haemost) Vol. 120 Issue 7 Pg. 1128-1136 (Jul 2020) ISSN: 2567-689X [Electronic] Germany
• PMID: 32365386 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: Georg Thieme Verlag KG Stuttgart · New York.

Chemical References

• Anticoagulants
• Factor Xa Inhibitors
• Heparin, Low-Molecular-Weight

Topics

• Administration, Oral
• Aged
• Anticoagulants (administration & dosage, adverse effects)
• Blood Coagulation (drug effects)
• Factor Xa Inhibitors (administration & dosage, adverse effects)
• Female
• Hemorrhage (chemically induced)
• Heparin, Low-Molecular-Weight (administration & dosage, adverse effects)
• Humans
• Male
• Middle Aged
• Neoplasms (blood, complications, diagnosis)
• Randomized Controlled Trials as Topic
• Recurrence
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome
• Venous Thromboembolism (blood, diagnosis, drug therapy, etiology)