Title:Direct Oral Anticoagulants for the Prevention and Treatment of Venous
Thromboembolic Events in Cancer Patients: A Meta-analysis of Randomized
Controlled Trials
Volume: 20
Issue: 1
Author(s): Loma Al-Mansouri*, Firas R. AL-Obaidi, Rafid Bashir Altaweel, Enrique Soto-Perez-de-Celis, Hasan Al- Farhan, Noor A Abdullah and Laith Alrubaiy
Affiliation:
- College of Medicine, University of Basrah, Basra, Iraq
- Basra Oncology Center, Basra, Iraq
Keywords:
Direct oral anticoagulants, cancer, neoplasm, thromboembolism, pulmonary embolism, deep venous thrombosis, low molecular weight heparin.
Abstract:
Introduction: Cancer is associated with a higher risk of venous thromboembolic events
compared to the general population. About one-fifth of patients diagnosed with venous thromboembolic
events have underlying cancer. The guidelines recommend both low molecular weight heparin
and direct oral anticoagulants for the prevention and treatment of venous thromboembolic events.
Further evidence is required to adequately characterize the exact role of direct oral anticoagulants.
Methods: A systematic review of the literature was done by searching the databases of Medline,
Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov. The analysis
included only randomized controlled trials enrolling adult patients with cancer and venous thromboembolic
events comparing low molecular weight heparin versus direct oral anticoagulants. Duration
of follow-up of at least 6 months was considered as a minimum. The studies had to assess the risk of
thromboembolic recurrence rate, all-cause mortality, and risk of bleeding.
Results: The final search results led to the inclusion of five randomized controlled trials. The analysis
showed a similar risk of recurrence of venous thrombotic events (RR 0.71, 95% CI 0.44-1.17; p =
0.18), mortality risk (RR 1.02, 95% CI 0.88-1.17; p = 0.8), and major bleeding (RR 1.05, 95% CI
0.69-1.62; p = 0.81) between the two treatment groups.
Conclusion: The use of direct oral anticoagulants is a feasible and practical option in ambulatory
cancer patients with venous thromboembolic events. The efficacy and safety are similar to that of low
molecular weight heparin.
