Key result
Direct oral anticoagulants showed no significant difference compared to low-molecular weight heparin in preventing VTE recurrence (HR 0.54) in patients with cancer-associated VTE.
Why the study?
The optimal choice of anticoagulation therapy in patients with malignancy and venous thromboembolism remains uncertain, with DOACs emerging as an alternative to standard LMWH.
Do direct oral anticoagulants (DOACs) reduce VTE recurrence or bleeding compared to low-molecular weight heparin (LMWH) in patients with cancer-associated VTE?
Meta-Analysis (n=2,907)
Open-label
Do direct oral anticoagulants (DOACs) reduce VTE recurrence or bleeding compared to low-molecular weight heparin (LMWH) in patients with cancer-associated VTE?
Hazard Ratio: 0.54 (95% CI 0.23–1.28)
p-value: p=0.23
DOACs are an acceptable and safe alternative to LMWH for the treatment of venous thromboembolism in patients with malignancy, showing comparable efficacy and safety profiles.
Supports DOACs over LMWH for cancer-associated VTE; strengthens guideline recommendations from pooled RCT data.
There is uncertainty about the choice of anticoagulation therapy in patients with malignancy and venous thromboembolism (VTE). While low-molecular weight heparin (LMWH) remains the current standard, direct oral anticoagulants (DOACs) have emerged as an appealing alternative option. The primary objective of this analysis was to compare the efficacy and safety of DOACs versus LMWH in patients with malignancy and VTE. The secondary objective was to compare the safety and efficacy of the different DOACs. An online search of PubMed, EMBASE, the Cochrane Library and ClinicalTrials.gov from inception until April 2020 was conducted. Four RCTs encompassing 2,907 patients, (50.5% men and mean age of 65.7 ± 10.5) were selected. At a mean follow up of 12 months, moderate certainty evidence showed no differences between DOAC and LMWH in VTE recurrence (HR, 0.54 [CI 0.23 to 1.28], I2 = 56%, p=0.23), in major bleeding (HR, 1.38 [CI 0.45 to 4.22], I2 = 33%, p=0.21) or clinically relevant non-major bleeding (CRNMB) (HR, 1.77 [CI 0.49 to 6.40], I2 = 73.9%, p=0.087). There was no difference between the DOACs when compared to each other. In conclusion, DOACs are an acceptable alternative to LMWHs for the treatment of VTE in patients with malignancy.
No takes yet. Share an insight, caveat, or question.
Saleem et al. (2020) conducted a meta-analysis in Venous thromboembolism associated with cancer (n=2,907). Direct oral anticoagulants (DOACs) vs. Low-molecular weight heparin (LMWH) was evaluated on VTE recurrence (HR 0.54, 95% CI 0.23 to 1.28, p=0.23). Direct oral anticoagulants showed no significant difference compared to low-molecular weight heparin in preventing VTE recurrence (HR 0.54) in patients with cancer-associated VTE.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: