Highlights
- •The clinical benefit of DOACs in patients with cancer and venous thromboembolism (CAT) is debated.
- •We compared the use of DOACs, VKAs or LMWHs in 4720 patients with CAT.
- •Risk of recurrent VTE was 50% lower in patients who received DOACs compared VKAs.
- •Risk of recurrent VTE was 30% lower in patients who received LMWHs compared to VKAs.
- •Overall rates of major bleedings were similar among the 3 treatment groups.
Abstract
Background
Low-molecular-weight heparins (LMWHs) are the recommended treatment for cancer-associated
venous thrombosis (CAT). Recent evidences suggest a role for direct-acting oral anticoagulants
(DOACs) in this clinical setting.
Methods
To evaluate the efficacy and safety of different anticoagulants we performed a network
meta-analysis of RCTs including patients with CAT treated with LMWHs, vitamin K antagonists
(VKAs) or DOACs. MEDLINE and EMBASE were searched up to February 2018. The primary
efficacy and safety outcomes were recurrent VTE and major bleeding, respectively.
Results
Overall, 4720 CAT patients from 12 studies were included: 1430 from 2 studies comparing
DOACs with LMWHs, 1212 from 4 studies comparing DOACs with VKAs and 2078 from 6 studies
comparing VKAs to LMWHs.
Recurrent VTE occurred in 4.9% of patients receiving DOACs, 9.6% receiving VKAs and
8.4% receiving LMWHs. The network meta-analysis showed a not significant increase
of recurrent VTE in patients receiving LMWHs compared to those receiving DOACs (RR
1.3, 95% CI 0.9 to 2.0). The risk of recurrent VTE was higher in patients receiving
VKAs compared to LMWHs (RR 1.5, 95% CI 1.0 to 2.0) or DOACs (RR 2.0, 95% CI 1.3 to
3.0) with no heterogeneity.
Major bleeding occurred in 4.9, 4.1 and 4.3% of patients with CAT treated with DOAC,
VKA or LMWH, respectively. No significant differences were observed from the direct,
indirect and network meta-analyses.
Conclusion
In patients with CAT, DOACs showed a good efficacy and safety profile compared to
other anticoagulants and is candidates to be an alternative to LMWHs.
Keywords
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Article info
Publication history
Published online: September 01, 2018
Accepted:
August 31,
2018
Received in revised form:
August 14,
2018
Received:
June 28,
2018
Footnotes
☆Authors declare that there are no conflict of interest for this manuscript.
☆No financial support was received for this study.
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
