Anticoagulants for the treatment of venous thromboembolism in patients with cancer: A comprehensive systematic review, pairwise and network meta-analysis

Sidahmed, Shima; Abdalla, Ahmed; Kheiri, Babikir; Bala, Areeg; Salih, Mohammed; Bachuwa, Ghassan; Kafri, Zyad; Kuderer, Nicole M.; Lyman, Gary H.

doi:10.1016/j.critrevonc.2020.103005

Cited by 11 publications

(10 citation statements)

References 31 publications

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“…VTE recurrence was also decreased with DOACs compared to VKA, with comparable [10] or decreased [11] bleeding risks. LMWH was associated with significantly reduced VTE recurrence compared with VKA [11].…”

Section: Overviewmentioning

confidence: 86%

“…The regimen of DOACs ± injectable has rapidly increased from < 1% in 2014 to 20% in 2017 [9]. In two recent meta-analyses, recurrent VTE incidence was significantly decreased with DOACs compared to LMWH [10,11], with comparable [10] or increased [11] bleeding risks. VTE recurrence was also decreased with DOACs compared to VKA, with comparable [10] or decreased [11] bleeding risks.…”

Section: Overviewmentioning

confidence: 99%

“…In recent years, with respect to DOACs vs LMWH, besides SELECT-D trial [37], six meta-analyses indicated that DOACs were more efficacious in the treatment of cancer-associated VTE with an increase of bleeding risk, compared with LMWH [11,20,[38][39][40][41], whereas a retrospective study [7] and another five meta-analyses [10,15,16,42,43] indicated that DOACs were more efficacious with a comparable bleeding risk, compared with LMWH. In the ADAM VTE trial, major bleeding and VTE recurrence rates were both lower in cancer patients with VTE receiving oral apixaban than those receiving dalteparin [44].…”

Section: Doacs Vs Lmwhmentioning

confidence: 99%

“…With regard to DOACs vs VKA in recent years, one retrospective study [7] and two meta-analyses [10,42] reported that DOACs were more efficacious in the treatment of cancer-associated VTE with similar bleeding risk compared to VKA, whereas another two metaanalyses [11,38] indicated that DOACs were more efficacious with a decrease of bleeding risk, compared to VKA. Besides, the Hokusai-VTE trial reported that DOAC (edoxaban) was as effective as VKA (warfarin) for the treatment of patients with cancer-associated VTE with less bleeding risk [48].…”

Section: Doacs Vs Vkamentioning

confidence: 99%

“…As for LMWH vs VKA, two meta-analyses [11,20] and one retrospective study [34] reported that LMWH was more efficacious in the treatment of cancer-associated VTE with similar bleeding risk compared with VKA, whereas the CATCH trial [49] and one meta-analysis indicated that the therapeutic efficacy for cancerassociated VTE and bleeding risk were both similar between LMWH and VKA [38].…”

Section: Lmwh Vs Vkamentioning

confidence: 99%

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Current status of treatment of cancer-associated venous thromboembolism

Xiong

2021

Thrombosis J

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Patients with cancer are prone to develop venous thromboembolism (VTE) that is the second leading cause of mortality among them. Cancer patients with VTE may encounter higher rates of VTE recurrence and bleeding complications than patients without cancer. Treatment of established VTE is often complex in patients with cancer. Treatment of cancer-associated VTE basically comprises initial treatment, long-term treatment, treatment within 6 months, treatment beyond 6 months, treatment of recurrent VTE, and treatment in special situations. Decision of antithrombotic therapy, selection of anticoagulants, duration of anticoagulation, decision of adjuvant therapy, and adjustment of regimen in special situations are the major problems in the treatment of cancer-associated VTE. Therapeutic anticoagulation is the key of the key in the treatment of cancer-associated VTE. In addition to the efficacy and safety of low-molecular-weight heparin (LMWH) that has been fully demonstrated, direct oral anticoagulants (DOACs) are increasingly showing its advantages along with the accompanying concern in the treatment of cancer-associated VTE. The latest ASCO, ITAC and NCCN guidelines agree with each other on most aspects with respect to the treatment of cancer-associated VTE, whereas differ on a few issues. Encompassing recent randomized controlled trials, clinical trials, and meta-analyses, as well as the comparison of the latest authoritative guidelines including the NCCN, ASCO, and ITAC guidelines in this field, the objective of this review is to present current overview and recommendations for the treatment of cancer-associated VTE.

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Section: Overviewmentioning

confidence: 86%

Section: Overviewmentioning

confidence: 99%

Section: Doacs Vs Lmwhmentioning

confidence: 99%

Section: Doacs Vs Vkamentioning

confidence: 99%

Section: Lmwh Vs Vkamentioning

confidence: 99%

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Current status of treatment of cancer-associated venous thromboembolism

Xiong

2021

Thrombosis J

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Efficacy of novel oral anticoagulants in active cancer patients: Using the venous thromboembolism protocol for an umbrella meta-analysis

Yang,

Hu,

Zhang

et al. 2024

Asian Journal of Surgery

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Assessment and Mitigation of Bleeding Risk in Atrial Fibrillation and Venous Thromboembolism: Executive Summary of a European and Asia-Pacific Expert Consensus Paper

et al. 2022

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While there is a clear clinical benefit of oral anticoagulation in patients with atrial fibrillation (AF) and venous thromboembolism (VTE) in reducing the risks of thromboembolism, major bleeding events (especially intracranial bleeds) may still occur and be devastating. The decision for initiating and continuing anticoagulation is often based on a careful assessment of both thromboembolism and bleeding risk. The more common and validated bleeding risk factors have been used to formulate bleeding risk stratification scores, but thromboembolism and bleeding risk factors often overlap. Also, many factors that increase bleeding risk are transient and modifiable, such as variable international normalized ratio values, surgical procedures, vascular procedures, or drug–drug and food–drug interactions. Bleeding risk is also not a static “one-off” assessment based on baseline factors but is dynamic, being influenced by aging, incident comorbidities, and drug therapies. In this executive summary of a European and Asia-Pacific Expert Consensus Paper, we comprehensively review the published evidence and propose a consensus on bleeding risk assessments in patients with AF and VTE, with a view to summarizing “best practice” when approaching antithrombotic therapy in these patients. We address the epidemiology and size of the problem of bleeding risk in AF and VTE, and review established bleeding risk factors and summarize definitions of bleeding. Patient values and preferences, balancing the risk of bleeding against thromboembolism, are reviewed, and the prognostic implications of bleeding are discussed. We propose consensus statements that may help to define evidence gaps and assist in everyday clinical practice.

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Anticoagulants for the treatment of venous thromboembolism in patients with cancer: A comprehensive systematic review, pairwise and network meta-analysis

Cited by 11 publications

References 31 publications

Current status of treatment of cancer-associated venous thromboembolism

Current status of treatment of cancer-associated venous thromboembolism

Efficacy of novel oral anticoagulants in active cancer patients: Using the venous thromboembolism protocol for an umbrella meta-analysis

Assessment and Mitigation of Bleeding Risk in Atrial Fibrillation and Venous Thromboembolism: Executive Summary of a European and Asia-Pacific Expert Consensus Paper

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