Key result
Direct oral anticoagulants significantly reduced recurrent VTE compared to LMWHs (5.2% vs 8.2%; RR 0.62, 95% CI 0.43-0.91) but increased bleeding risk, especially in patients with GI cancer.
Why the study?
Recent RCTs have compared DOACs with established LMWHs for cancer-associated VTE, prompting an updated systematic review and meta-analysis of their efficacy and safety.
Do direct oral anticoagulants (DOACs) reduce recurrent VTE and major bleeding compared to low-molecular-weight heparins (LMWHs) in patients with cancer-associated VTE?
Meta-Analysis (n=2,894)
Do direct oral anticoagulants (DOACs) reduce recurrent VTE and major bleeding compared to low-molecular-weight heparins (LMWHs) in patients with cancer-associated VTE?
Relative Risk: 0.62 (95% CI 0.43–0.91)
Absolute Event Rate: 5.2% vs 8.2%
In patients with cancer-associated VTE, DOACs are more effective than LMWHs in preventing recurrent VTE but carry a higher risk of clinically relevant nonmajor bleeding, particularly in patients with GI cancer.
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May favor DOACs over LMWH for cancer VTE prevention with bleeding caution; extends RCT meta-evidence for guideline refinement.
Moik et al. (2020) conducted a meta-analysis in cancer-associated venous thromboembolism (VTE) (n=2,894). Direct oral anticoagulants (DOACs) vs. Low-molecular-weight-heparins (LMWHs) was evaluated on recurrent VTE (RR 0.62, 95% CI 0.43-0.91). Direct oral anticoagulants significantly reduced recurrent VTE compared to LMWHs (5.2% vs 8.2%; RR 0.62, 95% CI 0.43-0.91) but increased bleeding risk, especially in patients with GI cancer.
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