Direct oral anticoagulants for venous thromboembolism in cancer patients: a systematic review and network meta-analysis

Wu, Shuyi; Lv, Meina; Chen, Jiana; Jiang, Shaojun; Chen, Mingrong; Fang, Zuxiang; Zeng, Zhiwei; Qian, Jiafen; Xu, Wenlin; Guan, Chengfu; Zhang, Jinhua

doi:10.1007/s00520-022-07433-4

Cited by 10 publications

(7 citation statements)

References 62 publications

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“…Various guidelines have established DOACs and LMWHs as an alternative to usual treatment to counteract side effects, such as bleeding and thrombocytopenia, in the prophylaxis and treatment of vascular diseases in cancer patients [33,34], with DOACs being more accepted due to their oral administration [35,36]. Multiple meta-analyses comparing LMWH and DOAC treatments were performed [37][38][39][40][41][42][43]. Some outcomes evaluated in each treatment showed no significant differences between LMWH and DOAC, with the latter being used as another treatment option for cancer-associated VTE [37][38][39][40][41][42][43].…”

Section: Discussionmentioning

confidence: 99%

“…Multiple meta-analyses comparing LMWH and DOAC treatments were performed [37][38][39][40][41][42][43]. Some outcomes evaluated in each treatment showed no significant differences between LMWH and DOAC, with the latter being used as another treatment option for cancer-associated VTE [37][38][39][40][41][42][43]. Other studies have concluded that among the drugs used for the prevention and treatment of VTE in cancer patients, DOACs have a greater efficacy and a relatively low risk of bleeding, and apixaban is the most effective and has the lowest risk of bleeding [37][38][39][40][41][42][43][44].…”

Section: Discussionmentioning

confidence: 99%

“…Some outcomes evaluated in each treatment showed no significant differences between LMWH and DOAC, with the latter being used as another treatment option for cancer-associated VTE [37][38][39][40][41][42][43]. Other studies have concluded that among the drugs used for the prevention and treatment of VTE in cancer patients, DOACs have a greater efficacy and a relatively low risk of bleeding, and apixaban is the most effective and has the lowest risk of bleeding [37][38][39][40][41][42][43][44]. However, some studies have reported that DOACs have an increased risk of major bleeding in patients with gastrointestinal and genitourinary malignancies [37][38][39][40][41][42][43].…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and Safety of Apixaban versus Dalteparin as a Treatment for Cancer-Associated Venous Thromboembolism: A Systematic Review and Meta-Analysis

Arce-Huamani,

Barboza,

Martínez-Herrera

et al. 2023

Medicina

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Background and Objectives: Venous thromboembolism (VTE) is common in cancer patients. Anticoagulant therapy with low-molecular-weight heparins (LMWHs) and direct oral anticoagulants (DOACs), such as dalteparin and apixaban, have demonstrated efficacy and safety. However, more comparative research of these drugs is still needed. This study aimed to synthesize evidence on the efficacy of apixaban compared to dalteparin in reducing recurrent VTE, major bleeding, and clinically relevant non-major bleeding associated with cancer. Materials and Methods: We systematically searched the PubMed, Scopus, Web of Science, Embase, Cochrane Library, and ClinicalTrials databases up to 5 January 2023, for randomized controlled trials comparing apixaban versus dalteparin as treatment for cancer-associated VTE. Five studies were included. Effects according to meta-analyses were reported as relative risks (RRs) and their 95% confidence intervals (CIs). Results: It was found that 33 of 734 (4.5%) patients treated with apixaban and 56 of 767 (7.3%) with dalteparin had recurrent VTE as the efficacy outcome (RR 0.49, 95% CI 0.15–1.58, I2 38%). Major bleeding occurred in 25 of 734 patients treated with apixaban (3.4%) and 27 of 767 with dalteparin (3.5%) (RR 1.29, 95% CI 0.31–5.27, I2 59%). Likewise, clinically relevant non-major bleeding occurred in 64 of 734 patients treated with apixaban (8.7%) and 46 of 767 (5.9%) with dalteparin (RR 1.52, 95% CI 1.05–2.19, I2 0%). Conclusions: Apixaban showed a lower risk of recurrent VTE than dalteparin in patients with cancer-associated VTE, but without statistical significance. No statistical significance was observed in clinically relevant major or non-major bleeding.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Efficacy and Safety of Apixaban versus Dalteparin as a Treatment for Cancer-Associated Venous Thromboembolism: A Systematic Review and Meta-Analysis

Arce-Huamani,

Barboza,

Martínez-Herrera

et al. 2023

Medicina

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“…[4][5][6][7] In addition, several meta-analyses have consistently suggested the utility of DOACs for cancer-associated VTE. [8][9][10][11][12][13][14] Therefore, several current guidelines recommend DOACs as a first-line treatment option for cancer-associated VTE. [7][8][9][10][11] However, the choice of DOACs is a major issue.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Edoxaban, Rivaroxaban, or Apixaban for Cancer-Associated Venous Thromboembolism in the Real World: Insights from the COMMAND VTE Registry-2

Sueta,

Yamashita,

Morimoto

et al. 2024

Thromb Haemost

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Background: Real-world data on clinical characteristics and outcomes related to the use of different direct oral anticoagulants (DOACs) for cancer-associated venous thromboembolism (VTE) is lacking. Methods: The COMMAND VTE Registry-2 is a multicenter registry enrolling 5,197 consecutive patients with acute symptomatic VTE from 31 centers in Japan from January 2015–August 2020. Our study population comprised 1,197 patients with active cancer who were divided into the edoxaban (N=643, 54%), rivaroxaban (N=297, 25%), and apixaban (N=257, 22%) groups. Results: The cumulative 5-year incidence of recurrent VTE (9.3%, 10.2%, and 8.5%, respectively, P=0.82) and all-cause death (67.5%, 66.8%, and 63.8%, respectively, P=0.22) did not differ among the groups. Despite adjusting for confounders, the risks of recurrent VTE and all-cause death did not differ significantly among the groups. The cumulative 5-year incidence of major and clinically relevant bleeding was significantly lower in the rivaroxaban group than those in the other groups (22.6%, 14.0%, and 22.8%, P=0.04; and 37.6%, 26.8%, and 38.3%, P=0.01, respectively). After adjusting for confounders, in the rivaroxaban group, the risk for major bleeding was numerically lower (HR: 0.65, 95% CI: 0.40–1.01) and that of clinically relevant all bleeding was significantly lower (HR: 0.67, 95% CI: 0.48–0.92) than those in the edoxaban group. Conclusions: The risks of recurrent VTE and all-cause death did not differ significantly among the different DOACs ; however, the risk of bleeding events could differ, with a potentially lower risk of bleeding with rivaroxaban.

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“…The efficacy and safety of direct oral anticoagulants (DOACs) for preventing and treating venous thromboembolism (VTE) in cancer patients is uncertain and several questions remain unanswered in this setting. In the current systematic review and network meta-analysis (NMA) published by Wu et al, the authors pulled together twenty clinical trials for a total of 6162 patients [1]. According to the results of the Bayesian NMA, Wu and colleagues suggested that apixaban may be considered as the most efficient and safest DOAC and presents better efficacy and relatively low bleeding risk among the VTE prevention and treatment drugs for patients with cancer [1].…”

Section: To the Editormentioning

confidence: 99%

Bayesian analysis supports the role of apixaban for cancer patients

Rizzo

2023

Support Care Cancer

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Direct oral anticoagulants for venous thromboembolism in cancer patients: a systematic review and network meta-analysis

Cited by 10 publications

References 62 publications

Efficacy and Safety of Apixaban versus Dalteparin as a Treatment for Cancer-Associated Venous Thromboembolism: A Systematic Review and Meta-Analysis

Efficacy and Safety of Apixaban versus Dalteparin as a Treatment for Cancer-Associated Venous Thromboembolism: A Systematic Review and Meta-Analysis

Edoxaban, Rivaroxaban, or Apixaban for Cancer-Associated Venous Thromboembolism in the Real World: Insights from the COMMAND VTE Registry-2

Bayesian analysis supports the role of apixaban for cancer patients

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