Michela Giustozzi1, Giancarlo Agnelli1, Jorge Del Toro-Cervera2, Frederikus A Klok3, Rachel P Rosovsky4, Anne-Céline Martin5,6, Joerg Herold7, Inna Tzoran8, Sebastian Szmit9, Laurent Bertoletti10, Cecilia Becattini1, Menno V Huisman3. 1. Internal Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Perugia, Italy. 2. Medicina Interna - Unidad de ETV, Hospital Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain. 3. Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands. 4. Hematology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States. 5. Hôpital Européen Georges Pompidou, Service de Cardiologie, F-75015, Paris, France. 6. Innovations Thérapeutiques en Hémostase, Université de Paris, INSERM, F-75006 Paris, France. 7. Department of Vascular Medicine, Technische Universität Darmstadt, Darmstadt, Germany. 8. Institute of Hematology and BMT Rambam Health Care Campus, Technion - Israel Institute of Technology, Haifa, Israel. 9. Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland. 10. Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, INSERM, UMR1059, Université Jean-Monnet, INSERM, CIC-1408, CHU Saint-Etienne, and INNOVTE, F-42055, Saint-Etienne, France.
Abstract
BACKGROUND: International guidelines have endorsed the use of edoxaban or rivaroxaban as an alternative to low-molecular-weight heparin (LMWH) for the treatment of acute venous thromboembolism (VTE) in cancer patients. Recently, a large randomized controlled trial of apixaban versus dalteparin in patients with cancer was completed. We performed an updated meta-analysis to assess the efficacy and safety of direct oral anticoagulants (DOACs) versus LMWH in patients with cancer-associated VTE. METHODS: MEDLINE, EMBASE, and CENTRAL (Cochrane Controlled Trials Registry) were systematically searched up to March 30, 2020 for randomized controlled trials comparing DOACs versus LMWH for the treatment of VTE in patients with cancer. The two coprimary outcomes were recurrent VTE and major bleeding at 6 months. Data were pooled by the Mantel-Haenszel method and compared by relative risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS: Four randomized controlled studies (2,894 patients) comparing apixaban, edoxaban, or rivaroxaban with dalteparin were included in the meta-analysis. Recurrent VTE occurred in 75 of 1,446 patients (5.2%) treated with oral factor Xa inhibitors and in 119 of 1,448 patients (8.2%) treated with LMWH (RR 0.62; 95% CI 0.43-0.91; I 2, 30%). Major bleeding occurred in 62 (4.3%) and 48 (3.3%) patients receiving oral factor Xa inhibitors or LMWH, respectively (RR 1.31; 95% CI 0.83-2.08; I 2, 23%). CONCLUSION: In patients with cancer-associated VTE, oral factor Xa inhibitors reduced the risk of recurrent VTE without a significantly higher likelihood of major bleeding at 6 months compared with LMWH. Georg Thieme Verlag KG Stuttgart · New York.
BACKGROUND: International guidelines have endorsed the use of edoxaban or rivaroxaban as an alternative to low-molecular-weight heparin (LMWH) for the treatment of acute venous thromboembolism (VTE) in cancerpatients. Recently, a large randomized controlled trial of apixaban versus dalteparin in patients with cancer was completed. We performed an updated meta-analysis to assess the efficacy and safety of direct oral anticoagulants (DOACs) versus LMWH in patients with cancer-associated VTE. METHODS: MEDLINE, EMBASE, and CENTRAL (Cochrane Controlled Trials Registry) were systematically searched up to March 30, 2020 for randomized controlled trials comparing DOACs versus LMWH for the treatment of VTE in patients with cancer. The two coprimary outcomes were recurrent VTE and major bleeding at 6 months. Data were pooled by the Mantel-Haenszel method and compared by relative risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS: Four randomized controlled studies (2,894 patients) comparing apixaban, edoxaban, or rivaroxaban with dalteparin were included in the meta-analysis. Recurrent VTE occurred in 75 of 1,446 patients (5.2%) treated with oral factor Xa inhibitors and in 119 of 1,448 patients (8.2%) treated with LMWH (RR 0.62; 95% CI 0.43-0.91; I 2, 30%). Major bleeding occurred in 62 (4.3%) and 48 (3.3%) patients receiving oral factor Xa inhibitors or LMWH, respectively (RR 1.31; 95% CI 0.83-2.08; I 2, 23%). CONCLUSION: In patients with cancer-associated VTE, oral factor Xa inhibitors reduced the risk of recurrent VTE without a significantly higher likelihood of major bleeding at 6 months compared with LMWH. Georg Thieme Verlag KG Stuttgart · New York.
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