Key result
DOACs reduce symptomatic VTE by ~77% in ambulatory cancer patients.
Why the study?
Venous thromboembolism is a common complication in cancer patients and the effect and safety of DOACs as primary prophylaxis in ambulatory cancer patients needed evaluation.
Do direct oral anticoagulants (DOACs) reduce symptomatic VTE incidence in ambulatory patients with cancer?
Meta-Analysis (n=1,465)
Do direct oral anticoagulants (DOACs) reduce symptomatic VTE incidence in ambulatory patients with cancer?
Relative Risk: 0.23 (95% CI 0.11–0.47)
p-value: p=<0.0001
DOACs are highly effective for primary thromboprophylaxis in ambulatory cancer patients, significantly reducing symptomatic VTE without a statistically significant increase in major bleeding.
Supports DOAC use for VTE prevention in selected high-risk ambulatory cancer patients; extends RCT evidence while underscoring need for bleeding-risk stratification.
Background: Venous thromboembolism (VTE) is a common complication in cancer patients. We aim to evaluate the effect and safety of direct oral anticoagulants (DOACs) as primary prophylaxis in ambulatory cancer patients.Methods: We conducted a literature search in PubMed, EMBASE and ClinicalTrials for studies that evaluated DOACs for thromboprophylaxis in cancer patients. RevMan 5.3 software was used for this meta-analysis.Results: Three randomized controlled trials (RCTs) with a total of 1465 patients were pooled in the meta-analysis. DOACs significantly reduced the symptomatic VTE incidence during intervention period (RR 0.23, CI 0.11-0.47, P<0.0001, I2=9%). Significantly lower total VTE incidence (RR 0.53, CI 0.36-0.78, P = 0.001, I2 =30%) and PE incidence (RR 0.50, CI 0.28-0.89, P = 0.02, I2 =5%) were found during the observation period, and a trend for less symptomatic DVT events was found in the DOACs group (RR 0.62, CI 0.37-1.04, P = 0.07, I2 =5%). No differences for all-cause mortality were found between groups (RR 0.92, CI 0.74-1.15, P = 0.47, I2 =14%). DOACs did not significantly increase major bleeding risks (RR 1.66, CI 0.72-3.83, P = 0.24, I2 =0%) during the intervention period or clinically relevant non-major bleeding events (RR 1.50, CI 0.90-2.49, P = 0.12, I2 =0%) and total bleeding events during the observation period (RR 1.50, CI 0.98-2.29, P = 0.06, I2 =0%).Conclusion: DOACs are effective for thromboprophylaxis in ambulatory cancer patients, but there is a potential risk of bleeding. DOACs may be recommended in selected patients at high risk of VTE. More high-quality studies are needed to further validate our results.Abbreviations: CAT: cancer-associated thrombosis; CI: confidence interval; DOAC: direct oral anticoagulant; DVT: deep vein thrombosis; LMWH: low molecular weight heparin; NNH: number needed to harm; NNT: number needed to treat; PE: pulmonary embolism; RCT: randomized controlled trials; RR: risk ratio; RD: rate difference; VTE: venous thromboembolism.
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Wang et al. (2020) conducted a meta-analysis in ambulatory cancer patients (n=1,465). Direct oral anticoagulants (DOACs) was evaluated on symptomatic VTE incidence during intervention period (RR 0.23, 95% CI 0.11-0.47, p=<0.0001). Direct oral anticoagulants significantly reduced the incidence of symptomatic venous thromboembolism in ambulatory cancer patients (RR 0.23; 95% CI 0.11-0.47; P<0.0001).
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