Thrombosis

Direct Oral Anticoagulants For Cancer-Associated Venous Thromboembolism: A Systematic Review And Meta-Analysis

Direct Oral Anticoagulants For Cancer-Associated Venous Thromboembolism: A Systematic Review And Meta-Analysis

Abstract

In the September 17, 2020 edition of the journal Blood, investigators reported on a systematic review and meta-analysis of the use of low molecular weight heparin and direct oral anticoagulants for cancer-associated venous thromboembolism.  

Medline, MBase, the Cochran central register of control trials, and conference proceedings were researched to look for relevant randomized control trials.  The primary efficacy and safety outcomes were major bleeding, and recurrent venous thromboembolism.  The composite of recurrent venous thromboembolism and major bleeding, clinically relevant nonmajor bleeding and all-cause mortality were another predefined set of composite outcomes. 2,607 patients were used in the primary analysis with the risk of recurrent venous thromboembolism not significantly lower with direct oral anticoagulants compared to low molecular weight heparins, relative risk, 0.68, 95% confidence interval, 0.39–1.17. 

The authors also stated that the risks of major bleeding, relative risk of 1.36, 95% confidence interval 0.55–3.35 and clinically relevant nonmajor bleeding, relative risk 1.63, 95% confidence interval, 0.73–3.64 were nonsignificantly higher.  The authors stated that the risk of composite of recurrent venous thromboembolism – major bleeding was nonsignificantly lower with direct oral anticoagulants compared to low molecular weight heparins, relative risk, 0.86, 95% confidence interval, 0.60–1.23.  The mortality was comparable between the 2 groups, relative risk 0.96, 95% confidence interval 0.68–1.36.  

The authors concluded “the findings were consistent during the on treatment period and in those with incidental venous thromboembolism.  Direct oral anticoagulants are an effective treatment option for patients with cancer and acute venous thromboembolism, although caution is needed in patients at high risk of bleeding”

https://ashpublications.org/Blood/article-abstract/136/12/1433/455308/Direct-oral-anticoagulants-for-cancer-associated?redirectedFrom=fulltext

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