Key result
NOACs fail to significantly reduce recurrent VTE compared to VKAs in cancer patients.
Why the study?
Do NOACs reduce recurrent VTE and clinically relevant bleeding compared to VKAs in cancer patients with VTE?
Meta-Analysis (n=19,060)
Yes
Do NOACs reduce recurrent VTE and clinically relevant bleeding compared to VKAs in cancer patients with VTE?
Odds Ratio: 0.56 (95% CI 0.28–1.13)
NOACs show a promising but statistically non-significant trend towards better efficacy and safety compared to VKAs for VTE treatment in cancer patients, limited by small sample sizes.
Nonsignificant trend favors NOACs for efficacy and safety in cancer-associated VTE; leaves open need for dedicated randomized trials.
BACKGROUND: This study sought to investigate the relative efficacy and safety of non-vitamin K oral anticoagulants (NOACs) for the treatment of venous thromboembolism (VTE) in cancer patients. METHODS: A systematic search of the PubMed, EMBASE, and ClinicalTrials.gov databases identified all multicentre, randomised phase III trials investigating the initial use of NOAC against a vitamin K antagonist (VKA) together with subcutaneous heparin or low molecular weight heparin (upstart) for treatment of VTE. Outcomes of interest were recurrent VTE (deep venous thrombosis or pulmonary embolism), and clinically relevant bleeding. RESULTS: Four randomised controlled phase III trials were included, comprising a total of 19,060 patients randomised to either NOAC or VKA. For patients with active cancer (N = 759), the analysis on the efficacy outcomes demonstrated a trend in favour of NOAC (OR 0.56, 95% CI 0.28-1.13). Similar, analyses on the safety outcomes comparing NOAC to VKA and enoxaparin demonstrated a trend in favour of NOAC (OR 0.88, 95% CI 0.57-1.35). CONCLUSION: Point estimates of the effect size suggest an important estimated beneficial effect of NOAC in the treatment of VTE in cancer, in terms of efficacy and safety, but given the small numbers of patients with cancer in the randomised trials, statistical significance was not achieved.
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Larsen et al. (2014) conducted a meta-analysis in Venous thromboembolism in cancer patients (n=19,060). Non-vitamin K oral anticoagulants (NOACs) vs. Vitamin K antagonist (VKA) with subcutaneous heparin or low molecular weight heparin was evaluated on Recurrent VTE (deep venous thrombosis or pulmonary embolism) (OR 0.56, 95% CI 0.28-1.13). Non-vitamin K oral anticoagulants showed a non-significant trend toward reduced recurrent VTE compared to vitamin K antagonists in cancer patients (OR 0.56; 95% CI 0.28-1.13).
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