Abstract Background Post-operative venous thromboembolism (VTE) remains a concern following cancer-related surgeries. Purpose This systematic review and meta-analysis aimed to evaluate the safety and efficacy of direct oral anticoagulants (DOACs) compared to low molecular weight heparin (LMWH) for thromboprophylaxis in this surgical setting. Methods We conducted a systematic search of PubMed, Embase, Scopus, and Web of Science for studies including patients undergoing cancer-related surgeries who received either DOACs or LMWH for post-operative thromboprophylaxis. The primary outcomes included VTE incidence (deep vein thrombosis and/or pulmonary embolism) and bleeding events (major bleeding and clinically relevant non-major bleeding). Secondary outcomes were all-cause mortality and hospitalization rates. Subgroup analyses were based on the type of DOAC (Apixaban or others), cancer type (gynecological, urological, or others), and follow-up duration (one month or three months). A random-effects model calculated pooled risk ratios (RRs) with 95% confidence intervals (CIs). Results Our analysis included 16 studies comprising 6400 participants in the DOAC group (mean age 62.05 years, 28.15% male) and 5801 participants in the LMWH group (mean age 60.78 years, 34.65% male). Comparing DOACs to LMWH for VTE prevention indicated that DOACs were non-inferior (RR=0.81, 95% CI 0.56 to 1.16). Additionally, the was no significant difference in total bleeding rates between the two anticoagulant classes (RR=0.70, 95% CI 0.70 to 1.18). No significant differences were observed in mortality or hospitalization rates between the DOAC and LMWH groups. Exploratory subgroup analyses suggested a possible reduction in VTE incidence with DOACs among patients undergoing surgery for urological cancers (RR=0.52, 95% CI 0.44 to 0.61) and trends toward lower total bleeding rate with the Apixaban subgroup (RR=0.64, 95% CI 0.44 to 0.94). Conclusions This meta-analysis indicates that DOACs are non-inferior to LMWH for post-operative thromboprophylaxis in patients undergoing cancer-related surgeries, with comparable safety profiles. The superior efficacy of DOACs in preventing VTE during urological cancer surgeries and the favorable safety profile of Apixaban warrant further investigation. Given the changing landscape of anticoagulation strategies in cancer care, additional research is essential to clearly define the roles of specific DOAC agents and optimal prophylactic approaches across various cancer types and surgical procedures.Figure 1.Graphical Abstract Figure 2.Subgroup analyses of outcomes
Hosseini et al. (Sat,) studied this question.