Rivaroxaban versus Low Molecular Weight Heparin for Cancer-Associated Venous Thromboembolism: A Systematic Review and Meta-Analysis

IntroductionVenous thromboembolism (VTE), which includes DVT and PE is a serious complication in cancer patients. This meta-analysis evaluates the efficacy and safety of rivaroxaban compared to LMWHs in treating cancer-associated VTE.MethodsFollowing PRISMA guidelines, we searched PubMed, Cochrane Library, Google Scholar, and ClinicalTrials.gov from inception to May 2025 for studies comparing rivaroxaban with low-molecular-weight heparins (LMWHs) in adults with cancer-associated VTE. Primary outcomes were VTE recurrence and all-cause mortality. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using a random-effects model. Risk of bias was assessed using RoB and NOS, with sensitivity and GRADE analyses performed.ResultsTwenty-five studies (n = 19,153, Rivaroxaban: 5186; LMWH: 13967) were included. Rivaroxaban significantly reduced the risk of VTE recurrence compared to LMWH (RR = 0.88; 95% CI: 0.78-0.99; P = 0.03). Rivaroxaban also significantly reduced all-cause mortality compared to LMWH (RR = 0.83; 95% CI: 0.69-0.99; P = 0.04). However, no statistically significant differences were noted in other outcomes. GRADE assessment showed evidence certainty ranged from high to very low.ConclusionRivaroxaban demonstrates lower all-cause mortality compared with LMWH, indicating a potential advantage in managing cancer-associated VTE. However, further large-scale RCTs are warranted to confirm its safety profile.