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Review
. 2025 Sep 24;6(5):e70155.
doi: 10.1002/jha2.70155. eCollection 2025 Oct.

Reduced Versus Full-Dose Direct Oral Anticoagulants for Venous Thromboembolism in Cancer Patients: A Systematic Review and Meta-Analysis

Danyal Bakht  1 , Muhammad Arham  2 , Zarwa Rashid  1 , Maaz Amir  1 , Zarish Nasir  1 , Mustabeen Zahra Naqvi  1 , Maleeha Tahir  1 , Musab Khalil  1 , Esha Gulzar  1 , Hafiz Muhammad Haris  1 , Kinza Bakht  2 , Allah Dad  2 , Haseeb Tareen  3 , Muhammad Numan Awais  4
Affiliations
Review

Reduced Versus Full-Dose Direct Oral Anticoagulants for Venous Thromboembolism in Cancer Patients: A Systematic Review and Meta-Analysis

Danyal Bakht et al. EJHaem. .

Abstract

Background: Venous thromboembolism (VTE) is a serious complication in cancer patients, with malignancy increasing the risk significantly. Direct oral anticoagulants (DOACs) have emerged as a convenient alternative to traditional therapies, though optimal dosing remains uncertain.

Methods: We performed a systematic review and meta-analysis on three studies. A comprehensive literature search was performed on PubMed, Embase, the Cochrane Library, and ScienceDirect till April 2025. Analysis was carried out on RevMan 5.4. The risk of bias was assessed via RoB 2.0.

Results: A total of three studies with 2416 participants were identified, including 1495 patients in the reduced-dose group and 1232 patients in the full-dose group. No significant difference was observed in recurrent VTE (OR 0.70, 95% CI 0.45-1.09, p = 0.11) or recurrent symptomatic VTE (OR 0.96, 95% CI 0.50-1.84, p = 0.91). However, reduced-dose DOACs were associated with a significantly lower incidence of incidental VTE (OR 0.31, 95% CI 0.14-0.69, p = 0.004). The reduced-dose group also had a lower incidence of CRNMB plus major bleeding (OR 0.69, 95% CI 0.55-0.88, p = 0.002).

Conclusions: In terms of venous thromboembolism, bleeding events, and all-cause mortality, reduced-dose DOACs demonstrated a safety profile that was either superior or comparable to that of full-dose DOACs.

Trial registration: The authors have confirmed clinical trial registration is not needed for this submission.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram for the systematic process of study selection.
FIGURE 2
FIGURE 2
Forest plot of recurrent venous thromboembolism outcomes.
FIGURE 3
FIGURE 3
Forest plot of VTE subtypes.
FIGURE 4
FIGURE 4
Forest plot of bleeding outcomes.
FIGURE 5
FIGURE 5
Forest plot of all‐cause mortality.
FIGURE 6
FIGURE 6
The risk of bias assessment ‐ using RoB‐2.0. The traffic plot and summary plot were drawn using robvis (visualization tool).
See this image and copyright information in PMC

References

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