Factor Xa inhibitors versus low molecular weight heparin for the treatment of cancer associated venous thromboembolism; A meta-analysis of randomized controlled trials and non-randomized studies

Hussain, Maryam; Ali, Faisal S.; Verghese, Dhiran; Myint, Phyo Thazin; Ahmed, Mashrafi; Gong, Zimu; Gerais, Yasmin A.; Siddiqui, Mahrukh; Troy, Kevin

doi:10.1016/j.critrevonc.2021.103526

Cited by 7 publications

(8 citation statements)

References 33 publications

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“…The GI tract was reported to be the most common bleeding site. Additionally, the risk of intracranial bleeding while treating CAVTE was presented as a significant concern [112]. Contrary to Hussain MR et al's findings, the risk of MB was reported not to increase during DOAC treatment; however, CRNMB and GI bleeding risk were reported to be increased, which is consistent with Hussain MR et al's meta-analysis.…”

Section: Could Doacs Be Used As a Substitute For Classic Anticoagulan...supporting

confidence: 57%

“…In another review, Xa inhibitors were shown to be comparable to LMWHs with regard to the risk of recurrent PEs. No significant difference was reported between Xa inhibitors and LMWHs in the risk of a fatal VTE; however, this was based on very low certainty evidence [112]. For patients who suffer from multiple myeloma and receive thalidomide-or lenalidomide-based regimens combined with chemotherapy and/or dexamethasone, as well as individuals with locally advanced or metastatic pancreatic cancer, the recommended anticoagulants are apixaban and rivaroxaban or LMWHs.…”

Section: Could Doacs Be Used As a Substitute For Classic Anticoagulan...mentioning

confidence: 99%

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Direct-Acting Oral Anticoagulant Therapy in Cancer Patients—A Review

Górnicki

Bułdyś

Zielińska³

et al. 2023

Cancers

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Venous thromboembolism (VTE) is an important aspect in cancer patients. There are various pharmacological methods used for thrombotic event treatment. DOACs (direct-acting oral anticoagulants) are gaining popularity among both physicians and researchers and are slowly starting to replace VKAs (vitamin K antagonists), thus becoming a substitute or alternative option for LMWHs (low-molecular-weight heparins). In this article, we present DOACs’ main therapeutic advantages and disadvantages in patients with cancer. The only major concern with using DOACs is the higher risk of bleeding; however, there are discrepancies in this matter. There are still some types of cancer for which DOACs are not recommended. Specific cancer types may influence the efficacy of DOAC therapy. Additionally, race and ethnicity may affect therapy in cancer patients with DOACs. A sizeable number of clinical trials are focused on comparing DOACs with other anticoagulants. The current guidelines of different scientific associations are not unanimous in their DOAC assessments. There is still a need for more evidence of DOACs’ potential advantages over other methods of anticoagulation in cancer patients to facilitate their position in this recommendation. This literature review presents the current state of knowledge about the use of DOACs in patients with neoplastic growth.

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Section: Could Doacs Be Used As a Substitute For Classic Anticoagulan...supporting

confidence: 57%

Section: Could Doacs Be Used As a Substitute For Classic Anticoagulan...mentioning

confidence: 99%

Direct-Acting Oral Anticoagulant Therapy in Cancer Patients—A Review

Górnicki

Bułdyś

Zielińska³

et al. 2023

Cancers

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“…Furthermore, the inclusion of patient populations with both active and nonactive cancer led to significant heterogeneity. 37 , 38 Consequently, these limited studies failed to identify any significant differences in safety outcomes among DOACs.…”

Section: Discussionmentioning

confidence: 99%

Comparing Anticoagulation Strategies for Venous Thromboembolism Associated With Active Cancer

Fujisaki,

Sueta,

Yamamoto

et al. 2024

JACC: CardioOncology

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“…Recently, Hussain et alperformed a meta-analysis of the risk of overall bleeding and recurrent VTE in cancer-associated thrombosis treated with factor Xa inhibitors compared with patients treated with LMWHs [ 35 ]. However, their meta-analysis had only 3 observational studies in the subgroup analysis of patients with GI cancer [ 35 ]. In contrast, our meta-analysis examined 11 studies on patients with GI cancer.…”

Section: Discussionmentioning

confidence: 99%

Direct oral anticoagulants versus low-molecular-weight heparins for the treatment of acute venous thromboembolism in patients with gastrointestinal cancer: a systematic review and meta-analysis

et al. 2022

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Background The association between gastrointestinal (GI) cancer and a high incidence of venous thromboembolism (VTE) is well known. Previous randomized controlled studies demonstrated that direct oral anticoagulants (DOACs) effectively treat cancer-associated thrombosis (CAT). However, some DOACs appeared to increase the risk of bleeding, particularly in patients with GI malignancies. Therefore, the current systematic review and meta-analysis were conducted to evaluate the safety and efficacy of DOACs in GI cancer-associated thrombosis. Methods Two investigators individually reviewed all studies that compared DOACs and low-molecular-weight heparins (LMWHs) in GI cancer-associated thrombosis and were published in MEDLINE and EMBASE before February 2022. The effect estimates and 95% confidence intervals (CIs) from each eligible study were combined using the Mantel–Haenszel method. Results A total of 2226 patients were included in the meta-analysis. The rates of major bleeding in the DOAC and LMWH groups were not significantly different (relative risk [RR]: 1.31; 95% CI: 0.84–2.04; P = 0.23; I2 = 41%). However, the rate of clinically relevant nonmajor bleeding (CRNMB) was significantly higher in the DOAC group (RR: 1.76; 95% CI: 1.24–2.52; P = 0.002; I2 = 8%). The risks of recurrent VTE in the groups did not significantly differ (RR: 0.72; 95% CI: 0.49–1.04; P = 0.08; I2 = 0%). Conclusions The current data suggest that treatment of GI cancer-associated thrombosis with DOACs significantly increases the risk of CRNMB. However, the risk of major bleeding was not significantly different. The efficacy of DOACs for preventing recurrent VTE in GI cancer was comparable to that of LMWHs. Trial registration INPLASY202180113.

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Factor Xa inhibitors versus low molecular weight heparin for the treatment of cancer associated venous thromboembolism; A meta-analysis of randomized controlled trials and non-randomized studies

Cited by 7 publications

References 33 publications

Direct-Acting Oral Anticoagulant Therapy in Cancer Patients—A Review

Direct-Acting Oral Anticoagulant Therapy in Cancer Patients—A Review

Comparing Anticoagulation Strategies for Venous Thromboembolism Associated With Active Cancer

Direct oral anticoagulants versus low-molecular-weight heparins for the treatment of acute venous thromboembolism in patients with gastrointestinal cancer: a systematic review and meta-analysis

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