scholarly journals Direct oral anticoagulant (DOAC) versus low-molecular-weight heparin (LMWH) for treatment of cancer associated thrombosis (CAT): A systematic review and meta-analysis

2019 ◽  
Vol 173 ◽  
pp. 158-163 ◽  
Author(s):  
Ang Li ◽  
David A. Garcia ◽  
Gary H. Lyman ◽  
Marc Carrier
Keyword(s):  
Systematic Review ◽  
Molecular Weight ◽  
Oral Anticoagulant ◽  
Low Molecular Weight Heparin ◽  
Meta Analysis ◽  
Low Molecular Weight ◽  
Direct Oral Anticoagulant ◽  
Cancer Associated Thrombosis

A single center retrospective cohort study comparing low-molecular-weight heparins to direct oral anticoagulants for the treatment of venous thromboembolism in patients with cancer – A real world experience

2018 ◽  
Vol 25 (4) ◽  
pp. 793-800 ◽  
Author(s):  
Megan K Phelps ◽  
Tracy E Wiczer ◽  
H Paige Erdeljac ◽  
Kelsey R Van Deusen ◽  
Kyle Porter ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Major Bleeding ◽  
Oral Anticoagulant ◽  
Low Molecular Weight Heparin ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Low Molecular Weight ◽  
Direct Oral Anticoagulant ◽  
Recurrent Cancer ◽  
Cancer Associated Thrombosis

Introduction Low-molecular-weight heparins are the standard treatment for cancer-associated thrombosis. Recently, direct oral anticoagulants are a new option for thrombosis treatment; however, data supporting the use of direct oral anticoagulants for cancer-associated thrombosis are limited. Objectives The primary objective of this study was to determine the rate of recurrent cancer-associated thrombosis and major bleeding within 6 months of starting either low-molecular-weight heparin or direct oral anticoagulant for treatment of cancer-associated thrombosis. Secondary objectives were to determine the rates of clinically relevant-non-major bleeding and all-cause mortality. Patients/methods This is a retrospective cohort study including adults with cancer-associated thrombosis treated with low-molecular-weight heparin or direct oral anticoagulant between 2010 and 2016 at the Ohio State University. Medical records were reviewed for 6 months after initiation of anticoagulation or until the occurrence of recurrent cancer-associated thrombosis, major bleeding, cessation of anticoagulation of interest, or death, whichever occurred first. Results Four hundred and eighty patients were included (290 low-molecular-weight heparin and 190 direct oral anticoagulant). Patients treated with direct oral anticoagulant were found to carry “lower risk” features including cancer with lower VTE risk and lower rate of metastatic disease. After adjustment for baseline differences, there was no significant difference in the rate of recurrent cancer-associated thrombosis (7.2% low-molecular-weight heparin vs 6.3% direct oral anticoagulant, p = 0.71) or major bleeding (7.6% low-molecular-weight heparin vs 2.6% direct oral anticoagulant, p = 0.08). Conclusions Our study demonstrates that in a select population of cancer patients with VTE, direct oral anticoagulant use can be as effective and safe compared to the standard therapy with low-molecular-weight heparin.

“direct Oral Anticoagulants Versus Low-molecular-weight Heparin for Acute Treatment of Venous Thromboembolism in Patients With Gastrointestinal Cancer: a Systematic Review and Meta-analysis”

2021 ◽  
Author(s):  
Tarinee Rungjirajittranon ◽  
Weerapat Owattanapanich ◽  
Yingyong Chinthammitr ◽  
Theera Ruchutrakool ◽  
Bundarika Suwanawiboon
Keyword(s):  
Systematic Review ◽  
Molecular Weight ◽  
Major Bleeding ◽  
Low Molecular Weight Heparin ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Low Molecular Weight ◽  
Gi Cancer ◽  
Cancer Associated Thrombosis

Abstract BackgroundThe 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 VTE (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 was conducted to evaluate the safety and efficacy of DOACs in GI cancer-associated thrombosis.MethodsAll relevant studies that compared DOACs and low-molecular-weight heparin (LMWH) in GI cancer-associated thrombosis that were published before December 2020 were individually searched in two databases (MEDLINE and EMBASE) by two investigators. The effect estimates and 95% confidence intervals (CI) from each eligible study were combined using the Mantel-Haenszel method.ResultsA total of 1,418 patients were included in this meta-analysis. The rate of major bleeding was not significantly different between groups (relative risk [RR]: 1.57, 95% CI: 0.93-2.65, P=0.09, I2=34%). However, the rate of clinically relevant non-major bleeding (CRNMB) was significantly higher in the DOACs group (RR: 1.98, 95% CI: 1.34-2.91, P=0.0005, I2=0%). The risk of recurrent VTE was not significantly different between groups (RR: 0.72, 95% CI: 0.41-1.28, P=0.27, I2=0%).ConclusionsThe current data suggests that treatment of GI cancer-associated thrombosis with DOACs significantly increases the risk of CRNMB, and a trend towards major bleeding risk in DOACs group. The efficacy of DOACs for preventing recurrent VTE in GI cancer was comparable to that of LMWHs.Trial registration: INPLASY202180113

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