Direct Oral Anticoagulants in Patients With Active Cancer
Key result
DOACs prove noninferior to dalteparin for preventing VTE recurrence without increasing major bleeding.
- RR 1.55
- 95% CI 1.19 to 2.03
- P=0.001
- n=2,907
Why the study?
Patients with cancer have increased risks of thromboembolism and anticoagulant-related bleeding, and recent trials suggested DOACs are noninferior to dalteparin for VTE prevention but have higher bleeding rates.
Do DOACs reduce VTE recurrence compared to dalteparin in patients with cancer with acute VTE?
Population
2,907 patients with cancer and acute VTE across 4 RCTs
Comparison
DOACs vs dalteparin
Design
Systematic analysis of randomized controlled trials
Authors
Discussion
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Member takes
Implication
May support DOAC preference over dalteparin for cancer VTE; extends prior noninferiority findings with bleeding caution.
Study Design
Type
Meta-Analysis (n=2,907)
Structured PICO
Do DOACs reduce VTE recurrence compared to dalteparin in patients with cancer with acute VTE?
P
Population
2,907 patients with cancer and acute VTE across 4 randomized controlled trials.
I
Intervention
Direct oral anticoagulants (DOACs)
C
Comparator
Dalteparin
O
Outcome
VTE recurrence, clinically relevant nonmajor bleeding (CRNMB), and major bleedinghard clinical
Main Result
Relative Risk: 1.55 (95% CI 1.19–2.03)
p-value: p=0.001
In patients with cancer-associated VTE, DOACs reduce VTE recurrence compared to dalteparin without increasing major bleeding, though they increase clinically relevant nonmajor bleeding, particularly in those with gastrointestinal malignancies.
Cite This Study
Sabatino et al. (2020) conducted a meta-analysis in Cancer with acute VTE (n=2,907). Direct oral anticoagulants (DOACs) vs. Dalteparin was evaluated on VTE recurrence (RR 1.55, 95% CI 1.19 to 2.03, p=0.001). DOACs were noninferior to dalteparin in preventing VTE recurrence (dalteparin vs DOACs RR 1.55; 95% CI 1.19-2.03; p=0.001) without significantly increasing major bleeding.