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Meta-Analysis
. 2022 May 21;15(1):69.
doi: 10.1186/s13045-022-01289-1.

Direct oral anticoagulant versus low molecular weight heparin for the treatment of cancer-associated venous thromboembolism: 2022 updated systematic review and meta-analysis of randomized controlled trials

Corinne Frere #  1   2 , Dominique Farge #  3   4   5   6 , Deborah Schrag  7 , Pedro H Prata  8   9   10 , Jean M Connors  11
Affiliations
Meta-Analysis

Direct oral anticoagulant versus low molecular weight heparin for the treatment of cancer-associated venous thromboembolism: 2022 updated systematic review and meta-analysis of randomized controlled trials

Corinne Frere et al. J Hematol Oncol. .

Abstract

International clinical practice guidelines have progressively endorsed direct oral anticoagulants (DOACs) as an alternative to low-molecular-weight heparins (LMWHs) monotherapy for the initial and long-term treatment of cancer-associated thrombosis (CAT). Several new randomized controlled trials (RCTs) have recently reported additional results on the safety and efficacy of DOACs in this setting. We performed an updated meta-analysis of all publicly available data from RCTs comparing DOACs with LMWHs for the treatment of CAT. Six RCTs enrolling 3690 patients with CAT were included. Compared with LMWHs, DOACs significantly decreased the risk of CAT recurrence (RR, 0.67; 95%CI, 0.52-0.85), with a non-significant increase in the risk of major bleeding (RR, 1.17; 95%CI, 0.82-1.67), a significant increase in the risk of clinically relevant nonmajor bleeding (RR 1.66; 95%CI, 1.31-2.09) and no difference in all-cause mortality rates. These results increase the level of certainty of available evidence supporting the use of DOACs as an effective and safe option for the treatment of CAT in selected cancer patients.

Keywords: Cancer; Direct oral anticoagulant; Low-molecular-weight heparin; Venous thromboembolism.

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Conflict of interest statement

C.F. reported receiving honoraria for participating as a speaker at satellite symposia organized by Bayer, Bristol Myers Squibb, and LEO Pharma; D.S. reported receiving compensation for speaking at a Pfizer satellite symposium in 2019, receiving services for editorial work for JAMA, and research funding from the AACR for project GENIE; J.M.C. reported receiving personal fees from Bristol Meyers Squibb, Pfizer, Abbott, Alnylam, Takeda, Roche, and Sanofi. D.F. and P.H.C have nothing to disclose.

Figures

Fig. 1
Fig. 1
Forest plots of Risk Ratios for Venous Thromboembolism (A), Major Bleeding (B), Clinically Relevant NonMajor Bleeding (C) and Overall Mortality (D)
See this image and copyright information in PMC

References

    1. Farge D, Frere C, Connors JM, Ay C, Khorana AA, Munoz A, Brenner B, Kakkar A, Rafii H, Solymoss S, Brilhante D, Monreal M, Bounameaux H, Pabinger I, Douketis J, International Initiative on Thrombosis and Cancer (ITAC) advisory panel. 2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol. 2019;20:e566–81. - PubMed
    1. Key NS, Khorana AA, Kuderer NM, Bohlke K, Lee AYY, Arcelus JI, Wong SL, Balaban EP, Flowers CR, Francis CW, Gates LE, Kakkar AK, Levine MN, Liebman HA, Tempero MA, Lyman GH, Falanga A. Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol. 2020;38:496–520. doi: 10.1200/JCO.19.01461. - DOI - PubMed
    1. Lyman GH, Carrier M, Ay C, Di Nisio M, Hicks LK, Khorana AA, Leavitt AD, Lee AYY, Macbeth F, Morgan RL, Noble S, Sexton EA, Stenehjem D, Wiercioch W, Kahale LA, Alonso-Coello P. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Adv. 2021;5:927–974. doi: 10.1182/bloodadvances.2020003442. - DOI - PMC - PubMed
    1. NCCN Guideline on Cancer-Associated Venous Thromboembolic Disease. Version 1. 2022. Available at https://www.nccn.org/ professionals/physician_gls/pdf/vte.pdf. Accessed March, 2022.
    1. Raskob GE, van Es N, Verhamme P, Carrier M, Di Nisio M, Garcia D, Grosso MA, Kakkar AK, Kovacs MJ, Mercuri MF, Meyer G, Segers A, Shi M, Wang T-F, Yeo E, Zhang G, Zwicker JI, Weitz JI, Büller HR, Hokusai VTE Cancer Investigators. Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism. N Engl J Med 2018; 378: 615–24 - PubMed

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