Direct Oral Anticoagulants Compared With Dalteparin for Treatment of Cancer-Associated Thrombosis: A Living, Interactive Systematic Review and Network Meta-analysis

Riaz, Irbaz Bin; Fuentes, Harry E; Naqvi, Syed Arsalan Ahmed; He, Huan; Sipra, Qurat-ul-Ain Riaz; Tafur, Alfonso; Padranos, Leslie; Wysokiński, Waldemar E.; Marshall, Ariela L.; Vandvik, Per Olav; Montori, Víctor M.; Bryce, Alan H.; Liu, Hongfang; Badgett, Robert G.; Murad, Mohammad Hassan; McBane, Robert D.

doi:10.1016/j.mayocp.2020.10.041

Cited by 20 publications

(25 citation statements)

References 56 publications

(108 reference statements)

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“…Unexpectedly, the mortality was signi cantly higher in LMWH group compared to rivaroxaban group. The trend of all-cause mortality in the present study was similar to an Asian-based retrospective study and two prospective trials, but the other trials with cancer-associated VTE did not show distinct comparisons among vitamin K antagonist, LMWH and DOACs [30][31][32][33][34]. Indeed, LMWH group had high proportion of central PE, intermediate-risk PE, CCI score ≥ 3, and receiving palliative oncotherapy during the study period, which suggested that the more advanced cancer stage and heavier thrombotic burden might contributed to the increased risks of VTE recurrence and mortality.…”

Section: Discussionsupporting

confidence: 83%

“…Hokusai and Caravaggio also reported similar results, with a reduction of VTE recurrence in DOACs group (edoxaban vs dalteparin: HR, 0.71; 95% CI, 0.48-1.06; apixaban vs dalteparin: HR, 0.63; 95% CI, 0.37-1.07) [17,18]. In a 2022 network meta-analysis, rivaroxaban was also associated with noted numerically lower rate of VTE recurrence (OR, 0.41; 95% CI, 0.16-0.95) and higher rate of CRNMB (OR, 4.09; 95% CI, 1.79-10.59) compared with dalteparin, which also accorded with the ndings summarized by Overvad et al [34,35].…”

Section: Discussionsupporting

confidence: 52%

“…SELECT-D trials indicated a signi cantly increased risk of CRNMB in rivaroxaban (HR, 3.76; 95% CI, 1.63-8.69), which corresponded to our study with a rising tendency of CRNMB in rivaroxaban group with no signi cant difference (HR, 1.13; 95% CI, 0.62-2.09). It was reported that rivaroxaban was ranked the least safe drug in CRNMB compared with dalteparin (OR, 4.09; 95% CI, 1.79-10.59) and other DOACs (rivaroxaban vs apixaban: OR, 2.73; 95% CI, 1.08-7.71; rivaroxaban vs edoxaban: OR, 2.99; 95% CI, 1.21-8.26) [34]. It re ected a special hemorrhagic vulnerability of cancer tissue to rivaroxaban rather than the speci c predilection for speci c cancer.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the efficacy and safety of rivaroxaban and low-molecular-weight heparin in Chinese lung cancer patients with nonhigh-risk pulmonary embolism

Song

Yang

Hou

et al. 2022

Preprint

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Background Data that guide selection of differing anticoagulant regimens for specific cancer-associated venous thromboembolism (VTE) are lacking. We aimed to compare the efficacy and safety of rivaroxaban and low-molecular-weight heparin (LMWH) against nonhigh-risk pulmonary embolism (PE) in Chinese lung cancer patients. Methods 446 Chinese lung cancer patients with nonhigh-risk PE who initiated treatment with rivaroxaban or LMWH were identified from Zhongshan Hospital database from 2016 to 2020. The primary outcomes were the composite event of VTE recurrence or major bleeding, and all-cause mortality. The secondary outcomes were VTE recurrence, major bleeding and clinically relevant non-major bleeding (CRNMB). Propensity score matching was used to balance baseline covariates. We conducted sensitivity analysis by stabilized inverse probability of treatment weighting and competing risk analysis by a Fine and Gray subdistribution hazard model. Results In propensity score-matched cohorts, a trend for lower rate of the composite outcome was found in rivaroxaban group compared to LMWH group (hazard ratio (HR), 0.73; 95% confidence interval (CI), 0.45–1.21; P = 0.22). All-cause mortality was significantly lower in rivaroxaban group than LMWH group (HR, 0.52; 95% CI, 0.36–0.75; P < 0.001), while rivaroxaban was similar to LMWH in the risks of VTE recurrence (HR, 0.69; 95% CI, 0.36–1.34; P = 0.28), major bleeding (HR, 0.79; 95% CI, 0.37–1.68; P = 0.54) and CRNMB (HR, 1.13; 95% CI, 0.62–2.09; P = 0.69). The primary and secondary outcomes favored rivaroxaban over LMWH in all the subgroups expect for central PE and intermediate-risk PE. The sensitivity analysis yielded similar results, and competing risk analysis was in accordance with the primary findings. Conclusions Rivaroxaban might be a promising alternative to LMWH as initial treatment for nonhigh-risk PE in lung cancer patients.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of the efficacy and safety of rivaroxaban and low-molecular-weight heparin in Chinese lung cancer patients with nonhigh-risk pulmonary embolism

Song

Yang

Hou

et al. 2022

Preprint

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“…A meta-analysis of aggregated efficacy and safety outcomes of these DOACs vs dalteparin showed a less frequent recurrent VTE with DOACs, but an increased risk of bleeding, especially in patients with gastrointestinal cancer [ 46 ]. A recent review confirmed DOACs as a standard of care for the treatment of CAT and showed that apixaban is particularly safe in patients with a high risk of bleeding [ 47 ].…”

Section: Pathophysiology Of Vte In Cancer Patientsmentioning

confidence: 99%

Multidisciplinary Care for the Prevention and Treatment of Venous Thromboembolism in Patients with Cancer-Associated Thrombosis (CAT): Impact of Educational Interventions on CAT-Related Events and on Patients’ and Clinicians’ Awareness

Zalunardo

Panzavolta

Bigolin

et al. 2022

Life

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Cancer is a leading cause of death. Venous thromboembolism (VTE) is an often-overlooked cause of morbidity and mortality in cancer patients that can be readily prevented and treated. Actions are needed to reduce the morbidity and mortality of patients with cancer-associated thrombosis (CAT). There is a need to increase awareness of the impact of CAT on cancer patients’ morbidity and mortality, on their quality of life and to understand the importance of more effective preventions and treatments of VTE in cancer patients. Moreover, it is of great importance to systematically assess the risk of VTE in regard to patients, cancer and treatment-related factors. Unfortunately, there are unmet clinical needs in the prevention and treatment of cancer-associated VTE. In this review, we discuss an action plan to ensure an increased awareness of and education on the issues that need to be addressed in order to improve the provision of appropriate prevention, early diagnosis and effective and safe treatment of VTE to all cancer patients and, ultimately, to reduce morbidity and mortality.

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“…There are resources on creating NMA network diagrams and forest plots for publication [4,5], but these are often complex and may not be clinically meaningful. Some groups have attempted to share NMA results using an open science approach by making their living NMAs available on websites [6][7][8][9], but these websites resemble traditional knowledge translation outputs such as journal publications and conference presentations; understanding the results is likely difficult for non-researcher knowledge users [10]. Clinicians and patients without training in interpreting NMA results would not likely be able to use this information directly for treatment decisions.…”

Section: Introductionmentioning

confidence: 99%

Development of a Website for a Living Network Meta-analysis of Atopic Dermatitis Treatments Using a User-Centered Design: Multimethod Study

Lau¹,

Agarwal²,

Parente³

et al. 2022

JMIR Dermatol

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Background A rapid expansion of systemic immunological treatment options for atopic dermatitis (AD) has created a need for clinically relevant and understandable comparative efficacy and safety information for patients and clinicians. Given the scarcity of head-to-head trials, network meta-analysis (NMA) is an alternative way to enable robust comparisons among treatment options; however, NMA results are often complex and difficult to directly implement in shared decision-making. Objective The aim of this study is to develop a website that effectively presents the results of a living systematic review and NMA on AD treatments to patient and clinician users. Methods We conducted a multimethod study using iterative feedback from adults with AD, adult caregivers of children with AD, dermatologists, and allergists within a user-centered design framework. We used questionnaires followed by workshops among patients and clinicians to develop and improve the website interface. Usability testing was done with a caregiver of a patient with eczema. Results Questionnaires were completed by 31 adults with AD or caregivers and 94 clinicians. Patients and caregivers felt it was very important to know about new treatments (20/31, 65%). Clinicians felt the lack of evidence-based comparisons between treatments was a barrier to care (55/93, 59%). “Avoiding dangerous side effects” was ranked as the most important priority for patients (weighted ranking 5.2/7, with higher ranking being more important), and “improving patients’ overall symptoms” was the most important priority for clinicians (weighted ranking 5.0/6). A total of 4 patients and 7 clinicians participated in workshops; they appreciated visualizations of the NMA results and found the website valuable for comparing different treatments. The patients suggested changes to simplify the interface and clarify terminology related to comparative efficacy. The user in the usability testing found the website intuitive to navigate. Conclusions We developed a website, “eczematherapies.com,” with a user-centered design approach. Visualizations of NMA results enable users to compare treatments as part of their shared decision-making process.

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Direct Oral Anticoagulants Compared With Dalteparin for Treatment of Cancer-Associated Thrombosis: A Living, Interactive Systematic Review and Network Meta-analysis

Cited by 20 publications

References 56 publications

Comparison of the efficacy and safety of rivaroxaban and low-molecular-weight heparin in Chinese lung cancer patients with nonhigh-risk pulmonary embolism

Comparison of the efficacy and safety of rivaroxaban and low-molecular-weight heparin in Chinese lung cancer patients with nonhigh-risk pulmonary embolism

Multidisciplinary Care for the Prevention and Treatment of Venous Thromboembolism in Patients with Cancer-Associated Thrombosis (CAT): Impact of Educational Interventions on CAT-Related Events and on Patients’ and Clinicians’ Awareness

Development of a Website for a Living Network Meta-analysis of Atopic Dermatitis Treatments Using a User-Centered Design: Multimethod Study

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