Direct oral anticoagulants for cancer associated venous thromboembolism treatment: a systematic review of the literature
DOI:
https://doi.org/10.35509/01239015.776Keywords:
Anticoagulants, Factor Xa Inhibitors, Neoplasms, Dalteparin, Venous thrombosisAbstract
Abstract
International guidelines have recommended use of edoxaban, apixaban, or rivaroxaban, as an alternative to low molecular weight heparins (LMWH) to treat venous thromboembolism (VTE) in cancer patients. Recently, multiple randomized trials comparing apixaban against dalteparin in cancer patients have been completed. We performed a systematic review of the literature to evaluate efficacy and safety of direct oral anticoagulants (DOACs) – specifically factor Xa inhibitors, compared to LMWH, in cancer associated VTE.
Methods
A search was performed in MEDLINE, EMBASE, and CENTRAL (Cochrane clinical trials registry) up to July 30, 2020. Randomized clinical trials, comparing DOACs against LMWH for the treatment of cancer associated VTE were included. Co-primary outcomes were recurrent VTE and major bleeding in 6 months. Risk of bias risk was analyzed with the Cochrane tool.
Results
Four randomized clinical trials with 2894 patients, comparing apixaban, edoxaban or rivaroxaban against dalteparin were included in the systematic review. The results of these studies show that DOACs are a safe and efficacious treatment option for most patients with cancer associated VTE. Additionally, DOACs must be used with caution in patients with high bleeding risk.
Conclusion
In patients with cancer associated venous thromboembolism, direct oral anticoagulants (specifically Factor Xa Inhibitors) were non inferior compared to low molecular weight heparin in recurrent VTE risk reduction, with no significant increase in major bleeding risk at six months.
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