Why the study?
Management of VTE with LMWH and VKA in cancer patients involves clinical challenges, leading to DOACs emerging as an alternative for cancer-associated thrombosis.
Do direct oral anticoagulants (DOAC) improve safety and efficacy compared to low molecular weight heparins (LMWH) in adults with cancer-associated venous thromboembolism?
Do direct oral anticoagulants (DOAC) improve safety and efficacy compared to low molecular weight heparins (LMWH) in adults with cancer-associated venous thromboembolism?
DOACs are a noninferior alternative to LMWH for cancer-associated thrombosis in patients with low bleeding risk, but LMWH remains preferred for those with gastrointestinal or genitourinary cancers.
Supports oral DOACs instead of LMWH injections in low-bleed-risk CAT; confirms RCT noninferiority and leaves open high-risk subgroups.
Venous thromboembolism (VTE) is reportedly the second common cause of death among cancer patients. Management of VTE with low molecular weight heparins (LMWH) and Vitamin K antagonists (VKA) is associated with significant clinical challenges that led to the emergence of direct oral anticoagulants (DOAC) as an alternative for the management of cancer-associated thrombosis (CAT). The objective of this review is to provide an updated review of the completed and upcoming randomized controlled clinical trials (RCT) comparing the safety and efficacy of DOAC versus LMWH in the management of CAT in adults. A comprehensive literature survey was conducted till 7th January 2021 to review the completed randomized controlled clinical trials (RCT) comparing the safety and efficacy of DOAC versus LMWH in the management of CAT in adults. In order to search for upcoming trials, the Cochrane library and clinicaltrials.org databases were surveyed until the same period. The author found four completed RCT of DOAC in the management of CAT. Apart from these, there were another four RCT that are either ongoing or are yet to publish data. DOAC were reported to be noninferior to LMWH in the treatment of cancer-associated thrombosis in cancer patients with low bleeding risk and without gastrointestinal or gastrourinary cancers. Among patients with gastrointestinal or gastrourinary cancers and VTE, LMWH are preferred.
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Mohamed Abdel-Latif (2022) studied this question.
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