Key result
Non-vitamin K antagonist oral anticoagulants demonstrated a superior narrow net clinical benefit compared to traditional anticoagulation in cancer patients.
Why the study?
Do NOACs improve net clinical benefit compared to traditional anticoagulants for VTE prophylaxis in patients with cancer?
Meta-Analysis (n=41,454)
Do NOACs improve net clinical benefit compared to traditional anticoagulants for VTE prophylaxis in patients with cancer?
NOACs provide a superior net clinical benefit compared to traditional anticoagulants for VTE prophylaxis in patients with cancer requiring long-term anticoagulation.
Answers are grounded in this paper and cite their sources.
Supports NOAC preference over traditional agents for cancer VTE; extends RCT meta-analyses with first dedicated NCB quantification.
Venous thromboembolism (VTE) is highly prevalent in patients with cancer. Non-vitamin K antagonist oral anticoagulants (NOACs), directly targeting the enzymatic activity of thrombin or factor Xa, have been shown to be as effective as and safer than traditional anticoagulation for VTE prophylaxis in no-cancer patients. However, related studies that focused on the anticoagulation in cancer patients are lacked, and almost no net clinical benefit (NCB) analyses that quantified both VTE events and bleeding events have been addressed in this fragile population. Therefore, we aim to investigate this issue using a systematic review and NCB analysis. A comprehensive search of Medline, Embase, and Cochrane Library were performed for randomized controlled trials (RCTs) that reported the VTE events and major bleeding of NOACs and traditional anticoagulants in patients with or without cancer. Odds ratios (ORs) and 95% confidence intervals (CIs) of VTE and bleeding events were calculated using a random-effects model. The primacy outcome of narrow NCB was calculated by pooling ORs of VTE and major bleeding, with a weighting of 1.0. Similarly, the broad NCB was calculated by pooling ORs of VTE and clinically relevant bleeding. Heterogeneity was assessed through I2 test and Q statistic, and subgroup analyses were performed on the basis of different patients (VTE patients or acutely ill patients), comparators (vitamin-K antagonists or low-molecular-weight heparin), and follow-up duration (≤ 6 months or > 6 months). Overall, 9 RCTs including 41454 patients were enrolled, of which 2902 (7%) were cancer patients, and 38552 (93%) were no-cancer patients; 20712 (50%) were administrated with NOACs and 20742 (50%) were administrated with traditional anticoagulants. The use of NOACs had a superior NCB than traditional anticoagulation in both cancer patients (OR: 0.68, 95%CI: 0.50-0.85 for narrow NCB; OR: 0.76, 95%CI: 0.61-0.91 for broad NCB) and no-cancer patients (OR: 0.75, 95%CI: 0.54-0.96 for narrow NCB; OR: 0.85, 95%CI: 0.67-1.04 for broad NCB), with the estimates mainly from VTE patients receiving long-term warfarin treatment. In conclusion, NOACs may represent a better NCB property compared to traditional anticoagulants in cancer patients who need long-term anticoagulation treatment.
No takes yet. Share an insight, caveat, or question.
Yan et al. (2018) conducted a meta-analysis in Venous thromboembolism in patients with cancer (n=41,454). Non-vitamin K antagonist oral anticoagulants (NOACs) vs. Traditional anticoagulants (vitamin-K antagonists or low-molecular-weight heparin) was evaluated on Narrow net clinical benefit (composite of VTE and major bleeding events) in cancer patients (OR 0.68, 95% CI 0.50-0.85). Non-vitamin K antagonist oral anticoagulants demonstrated a superior narrow net clinical benefit compared to traditional anticoagulation in cancer patients.
Synapse has enriched 10 related papers. Consider them for comparative context: