Systematic review and meta-analysis of DOACs versus LMWH in Cancer-Associated venous Thrombosis

Abstract

<p>Introduction: Cancer-associated venous thrombosis (CAT) is a condition associated with high<br>mortality rates. However, limited evidence exists regarding the effectiveness and safety of lowmolecular-<br>weight heparin (LMWH) and direct oral anticoagulants (DOACs) for its treatment.<br>Aims: Using data from multiple clinical and real-world studies, we conducted a systematic review and<br>meta-analysis to compare the effectiveness and safety of DOACs to LMWH in patients with CAT.<br>Methods: We conducted a systematic search of PubMed, Embase, and Cochrane Library databases<br>up to May 31, 2023, for relevant randomized controlled trials (RCTs) and cohort studies comparing<br>DOACs to LMWH in patients with CAT. Two reviewers independently screened the studies, assessed<br>the risk of bias, and extracted data. Meta-analyses were performed separately for RCTs and cohort<br>studies with a specified 6-month follow-up period. Risk ratios (RRs) were calculated and pooled using<br>the random-effects model.<br>Results: The systematic review included five RCTs and 20 cohort studies. After applying the six-month<br>follow-up criterion, 17 articles with a total of 22,941 patients were analyzed in the meta-analysis. In<br>RCTs, DOACs were associated with a lower risk of VTE recurrence (RR 0.66, 95% CI 0.49-0.87)<br>compared to LMWH, with no significant differences in major bleeding (RR 1.31, 95% CI 0.85-2.03) and<br>all-cause mortality (RR 0.99, 95% CI 0.84-1.71). Cohort studies showed a lower risk of VTE recurrence<br>(RR 0.71, 95% CI 0.62-0.80) with DOACs, no significant difference in major bleeding (RR 0.89, 95% CI<br>0.65-1.22), and a reduced risk of all-cause mortality (RR 0.46, 95% CI 0.25-0.85).<br>Conclusions: The findings from both RCTs and cohort studies indicate that DOACs significantly reduce<br>the recurrence of VTE in patients with CAT without increasing the risk of major bleeding or all-cause<br>mortality compared to LMWH. These results suggest that DOACs may provide a superior<br>anticoagulation effect for CAT compared to LMWH.<br></p>