Maria Cristina Vedovati1, Federico Germini2, Giancarlo Agnelli2, Cecilia Becattini2. 1. Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Perugia, Italy. Electronic address: mcristinaved@yahoo.it. 2. Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Perugia, Italy.
Abstract
BACKGROUND: Direct oral anticoagulants (DOAs) have been shown to be as effective and at least as safe as conventional anticoagulation for the prevention of recurrences in patients with VTE. Whether this is the case in patients with cancer-associated VTE remains undefined. METHODS: We performed a meta-analysis of randomized controlled trials with the aim of assessing the efficacy and safety of DOAs in patients with VTE and cancer. MEDLINE, EMBASE, and CENTRAL were searched up to December 2013 with no language restriction. The primary outcome of the analysis was recurrent VTE. Data on major bleeding (MB) and clinically relevant nonmajor bleeding were analyzed. Data were pooled and compared by ORs and 95% CIs. RESULTS: Overall, 10 studies comparing DOAs with conventional anticoagulation for treatment of VTE including patients with cancer were included in the review. Six studies were included in the meta-analysis (two with dabigatran, two with rivaroxaban, one with edoxaban, and one with apixaban), accounting for a total of 1,132 patients. VTE recurred in 23 of 595 (3.9%) and in 32 of 537 (6.0%) patients with cancer treated with DOAs and conventional treatment, respectively (OR, 0.63; 95% CI, 0.37-1.10; I2, 0%). MB occurred in 3.2% and 4.2% of patients receiving DOAs and conventional treatment, respectively (OR, 0.77; 95% CI, 0.41-1.44; I2, 0%). CONCLUSIONS: DOAs seem to be as effective and safe as conventional treatment for the prevention of VTE in patients with cancer. Further clinical trials in patients with cancer-associated VTE should be performed to confirm these results.
BACKGROUND: Direct oral anticoagulants (DOAs) have been shown to be as effective and at least as safe as conventional anticoagulation for the prevention of recurrences in patients with VTE. Whether this is the case in patients with cancer-associated VTE remains undefined. METHODS: We performed a meta-analysis of randomized controlled trials with the aim of assessing the efficacy and safety of DOAs in patients with VTE and cancer. MEDLINE, EMBASE, and CENTRAL were searched up to December 2013 with no language restriction. The primary outcome of the analysis was recurrent VTE. Data on major bleeding (MB) and clinically relevant nonmajor bleeding were analyzed. Data were pooled and compared by ORs and 95% CIs. RESULTS: Overall, 10 studies comparing DOAs with conventional anticoagulation for treatment of VTE including patients with cancer were included in the review. Six studies were included in the meta-analysis (two with dabigatran, two with rivaroxaban, one with edoxaban, and one with apixaban), accounting for a total of 1,132 patients. VTE recurred in 23 of 595 (3.9%) and in 32 of 537 (6.0%) patients with cancer treated with DOAs and conventional treatment, respectively (OR, 0.63; 95% CI, 0.37-1.10; I2, 0%). MB occurred in 3.2% and 4.2% of patients receiving DOAs and conventional treatment, respectively (OR, 0.77; 95% CI, 0.41-1.44; I2, 0%). CONCLUSIONS: DOAs seem to be as effective and safe as conventional treatment for the prevention of VTE in patients with cancer. Further clinical trials in patients with cancer-associated VTE should be performed to confirm these results.
Authors: Domenico Prisco; Walter Ageno; Cecilia Becattini; Armando D'Angelo; Giovanni Davì; Raimondo De Cristofaro; Francesco Dentali; Giovanni Di Minno; Anna Falanga; Gualberto Gussoni; Luca Masotti; Gualtiero Palareti; Pasquale Pignatelli; Roberto M Santi; Francesca Santilli; Mauro Silingardi; Antonella Tufano; Francesco Violi Journal: Intern Emerg Med Date: 2017-02-13 Impact factor: 3.397
Authors: Hanno Riess; Cihan Ay; Rupert Bauersachs; Cecilia Becattini; Jan Beyer-Westendorf; Francis Cajfinger; Ian Chau; Alexander T Cohen; Alok A Khorana; Anthony Maraveyas; Marcos Renni; Annie M Young Journal: Oncologist Date: 2018-04-12