Key result
DOACs significantly decreased the risk of recurrent VTE compared with conventional anticoagulants in patients with cancer associated thrombosis (RR 0.65; 95% CI 0.49-0.86 for RCTs).
Why the study?
Observational studies have emerged assessing real-world comparative effectiveness and safety of DOACs in cancer-associated thrombosis, prompting an evaluation of whether their treatment effect estimates align with those from randomized controlled trials.
Do DOACs reduce recurrent VTE and major bleeding compared to conventional anticoagulants in patients with cancer-associated thrombosis?
Meta-Analysis (n=37,744)
Do DOACs reduce recurrent VTE and major bleeding compared to conventional anticoagulants in patients with cancer-associated thrombosis?
Relative Risk: 0.65 (95% CI 0.49–0.86)
DOACs are effective for treating cancer-associated thrombosis, reducing recurrent VTE without increasing overall major bleeding compared to conventional anticoagulants, with consistent results between observational studies and RCTs.
Supports DOAC preference in cancer-associated thrombosis; confirms reduced recurrent VTE without increased major bleeding.
Background: There are emerging observational studies (OSs) to assess real-world comparative effectiveness and safety of direct oral anticoagulants (DOACs) in cancer associated thrombosis (CAT). We conducted a pooled and interaction analysis to compare the treatment effect estimates of DOACs between OSs and randomized controlled trials (RCTs). Methods: We systematically searched PUBMED, EMBASE and Cochrane Library for OSs and RCTs that reported recurrent venous thromboembolism (VTE) and/or major bleeding events in CAT patients receiving DOACs and conventional anticoagulants [warfarin or low molecular-weight heparins (LMWHs)]. Relative risks (RRs) for OSs and RCTs were calculated using random-effects models separately, and interaction analyses were afterward applied to assess the comparability between OSs and RCTs. Results: Baseline characteristic was comparable between identified 10 OSs (35,142 patients) and 8 RCTs (2,602 patients). Overall, no significant difference of treatment effect estimates between OSs and RCTs was detected (Pinteraction: 0.42 for recurrent VTE; Pinteraction: 0.38 for major bleeding). DOACs significantly decreased the risk of recurrent VTE compared with conventional anticoagulants in CAT patients (RR: 0.74, 95% CI: 0.63–0.86, I2: 0% for OSs; RR: 0.65, 95% CI: 0.49–0.86; I2: 0% for RCTs), without increasing major bleeding risk (RR: 0.90, 95% CI: 0.76–1.07, I2: 24.0% for OSs; RR: 1.17, 95% CI: 0.72–1.88, I2: 26.2% for RCTs). Whereas, increased risk of gastrointestinal bleeding (GIB) was found with DOACs versus conventional anticoagulants in CAT patients (RR: 2.77, 95% CI: 1.35–5.68, I2: 0% for RCTs). Analyses of subgroups, based on comparators and follow-up duration, did not significantly affect results. Conclusions: In this study, effectiveness and safety of DOACs versus conventional anticoagulants in CAT from OSs are in agreement with those from RCTs, confirming a low risk of recurrent VTE and similar risk of major bleeding in CAT patients receiving DOACs.
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Gu et al. (2020) conducted a meta-analysis in Cancer associated thrombosis (CAT) (n=37,744). Direct oral anticoagulants (DOACs) vs. Conventional anticoagulants (warfarin or low molecular-weight heparins) was evaluated on Recurrent venous thromboembolism (VTE) (RR 0.65, 95% CI 0.49-0.86). DOACs significantly decreased the risk of recurrent VTE compared with conventional anticoagulants in patients with cancer associated thrombosis (RR 0.65; 95% CI 0.49-0.86 for RCTs).
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