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Direct Oral Anticoagulants in Patients with Venous Thromboembolism and Cancer: A Systematic Review and Meta-Analysis.
Chest. 2014 Sep 11;
Authors: Vedovati MC, Germini F, Agnelli G, Becattini C
Abstract
Abstract: BackgroundDirect oral anticoagulants (DOA) have been shown to be as effective and at least as safe as conventional anticoagulation for the prevention of recurrences in patients with venous thromboembolism (VTE). Whether this is the case in patients with cancer-associated VTE remains undefined. MethodsWe performed a meta-analysis of randomized controlled trials with the aim of assessing the efficacy and safety of DOA in patients with VTE and cancer. MEDLINE, EMBASE and CENTRAL were searched up to December 2013 with no language restriction. The primary outcome of the analysis was recurrent VTE. Data on major (MB) and clinically relevant non-major bleedings were analyzed. Data were pooled and compared by odds ratios (ORs) and 95% confidence intervals (CIs). ResultsOverall, 10 studies comparing DOA with conventional anticoagulation for treatment of VTE including patients with cancer were included in the review. Six studies were included in the meta-analysis (2 with dabigatran, 2 rivaroxaban, 1 edoxaban and 1 apixaban), accounting for a total of 1132 patients. VTE recurred in 23 of 595 (3.8%) and in 32 of 537 (5.9%) cancer patients treated with DOA and conventional treatment, respectively (OR 0.63, 95% CI 0.37 to 1.10; I-squared 0%). MB occurred in 3.2 and 4.2% of patients receiving DOA and conventional treatment, respectively (OR 0.77, 95% CI 0.41 to 1.44; I-squared 0%). ConclusionsDOA seems to be as effective and safe as conventional treatment for prevention of VTE in cancer patients. Further clinical trials in patients with cancer-associated VTE should be performed to confirm these results.
Background: Direct oral anticoagulants (DOA) have been shown to be as effective and at least as safe as conventional anticoagulation for the prevention of recurrences in patients with venous thromboembolism (VTE). Whether this is the case in patients with cancer-associated VTE remains undefined.
Methods: We performed a meta-analysis of randomized controlled trials with the aim of assessing the efficacy and safety of DOA in patients with VTE and cancer. MEDLINE, EMBASE and CENTRAL were searched up to December 2013 with no language restriction. The primary outcome of the analysis was recurrent VTE. Data on major (MB) and clinically relevant non-major bleedings were analyzed. Data were pooled and compared by odds ratios (ORs) and 95% confidence intervals (CIs).
Results: Overall, 10 studies comparing DOA with conventional anticoagulation for treatment of VTE including patients with cancer were included in the review. Six studies were included in the meta-analysis (2 with dabigatran, 2 rivaroxaban, 1 edoxaban and 1 apixaban), accounting for a total of 1132 patients. VTE recurred in 23 of 595 (3.8%) and in 32 of 537 (5.9%) cancer patients treated with DOA and conventional treatment, respectively (OR 0.63, 95% CI 0.37 to 1.10; I-squared 0%). MB occurred in 3.2 and 4.2% of patients receiving DOA and conventional treatment, respectively (OR 0.77, 95% CI 0.41 to 1.44; I-squared 0%).
Conclusions: DOA seems to be as effective and safe as conventional treatment for prevention of VTE in cancer patients. Further clinical trials in patients with cancer-associated VTE should be performed to confirm these results.
PMID: 25211264 [PubMed - as supplied by publisher]