Efficacy and Safety of Direct Oral Anticoagulants for Risk of Cancer-Associated Venous Thromboembolism
Efficacy and safety of direct oral anticoagulants (DOACs) for preventing primary and recurrent venous thromboembolism (VTE) in patients with cancer remain unclear. In this study, we conducted a systematic review to summarize the most up-to-date evidence from randomized controlled trials (RCTs). Our...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2019-05-01
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| Series: | Clinical and Applied Thrombosis/Hemostasis |
| Online Access: | https://doi.org/10.1177/1076029619853629 |
| _version_ | 1819023821356662784 |
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| author | Jie Zeng MSc Xuhui Zhang MD Gregory Y. H. Lip MD Xiaochen Shu MD Lehana Thabane PhD Junzhang Tian MD Guowei Li PhD, MSc, MBBS |
| author_facet | Jie Zeng MSc Xuhui Zhang MD Gregory Y. H. Lip MD Xiaochen Shu MD Lehana Thabane PhD Junzhang Tian MD Guowei Li PhD, MSc, MBBS |
| author_sort | Jie Zeng MSc |
| collection | DOAJ |
| description | Efficacy and safety of direct oral anticoagulants (DOACs) for preventing primary and recurrent venous thromboembolism (VTE) in patients with cancer remain unclear. In this study, we conducted a systematic review to summarize the most up-to-date evidence from randomized controlled trials (RCTs). Our primary outcomes included the benefit outcome (VTE) and safety outcome (major bleeding). A random-effects model was used to pool the relative risks (RRs) for data syntheses. The Grading of Recommendations Assessment, Development and Evaluation tool was used to evaluate the quality of the entire body of evidence across studies. We included 11 RCTs with a total of 3741 patients with cancer for analyses. The DOACs were significantly related with a reduced risk of VTE when compared with non-DOACs: RR = 0.77, 95% confidence interval [CI]: 0.61-0.99, P = .04. Nonsignificant trend towards a higher risk of major bleeding was found in DOACs: RR = 1.28 95% CI: 0.81-2.02, P = .29. The quality of the entire body of evidence was graded as moderate for risk of VTE, and low for risk of major bleeding. To summarize, DOACs were found to have a favorable effect on risk of VTE but a nonsignificant higher risk of major bleeding compared with non-DOACs in patients with cancer. The safety effect of DOACs in patients with cancer requires further evaluation in adequately powered and designed studies. |
| first_indexed | 2024-12-21T04:44:59Z |
| format | Article |
| id | doaj.art-c654cb7c261f4500a74d2da69f805886 |
| institution | Directory Open Access Journal |
| issn | 1938-2723 |
| language | English |
| last_indexed | 2024-12-21T04:44:59Z |
| publishDate | 2019-05-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Clinical and Applied Thrombosis/Hemostasis |
| spelling | doaj.art-c654cb7c261f4500a74d2da69f8058862022-12-21T19:15:37ZengSAGE PublishingClinical and Applied Thrombosis/Hemostasis1938-27232019-05-012510.1177/1076029619853629Efficacy and Safety of Direct Oral Anticoagulants for Risk of Cancer-Associated Venous ThromboembolismJie Zeng MSc0Xuhui Zhang MD1Gregory Y. H. Lip MD2Xiaochen Shu MD3Lehana Thabane PhD4Junzhang Tian MD5Guowei Li PhD, MSc, MBBS6 School of Public Health, Southern Medical University, Guangzhou, China Department of Oncology No.2, Guangdong Second Provincial General Hospital, Guangzhou, China Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark Department of Epidemiology, School of Public Health, Soochow University, Suzhou, China St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China St. Joseph’s Healthcare Hamilton, Hamilton, ON, CanadaEfficacy and safety of direct oral anticoagulants (DOACs) for preventing primary and recurrent venous thromboembolism (VTE) in patients with cancer remain unclear. In this study, we conducted a systematic review to summarize the most up-to-date evidence from randomized controlled trials (RCTs). Our primary outcomes included the benefit outcome (VTE) and safety outcome (major bleeding). A random-effects model was used to pool the relative risks (RRs) for data syntheses. The Grading of Recommendations Assessment, Development and Evaluation tool was used to evaluate the quality of the entire body of evidence across studies. We included 11 RCTs with a total of 3741 patients with cancer for analyses. The DOACs were significantly related with a reduced risk of VTE when compared with non-DOACs: RR = 0.77, 95% confidence interval [CI]: 0.61-0.99, P = .04. Nonsignificant trend towards a higher risk of major bleeding was found in DOACs: RR = 1.28 95% CI: 0.81-2.02, P = .29. The quality of the entire body of evidence was graded as moderate for risk of VTE, and low for risk of major bleeding. To summarize, DOACs were found to have a favorable effect on risk of VTE but a nonsignificant higher risk of major bleeding compared with non-DOACs in patients with cancer. The safety effect of DOACs in patients with cancer requires further evaluation in adequately powered and designed studies.https://doi.org/10.1177/1076029619853629 |
| spellingShingle | Jie Zeng MSc Xuhui Zhang MD Gregory Y. H. Lip MD Xiaochen Shu MD Lehana Thabane PhD Junzhang Tian MD Guowei Li PhD, MSc, MBBS Efficacy and Safety of Direct Oral Anticoagulants for Risk of Cancer-Associated Venous Thromboembolism Clinical and Applied Thrombosis/Hemostasis |
| title | Efficacy and Safety of Direct Oral Anticoagulants for Risk of Cancer-Associated Venous Thromboembolism |
| title_full | Efficacy and Safety of Direct Oral Anticoagulants for Risk of Cancer-Associated Venous Thromboembolism |
| title_fullStr | Efficacy and Safety of Direct Oral Anticoagulants for Risk of Cancer-Associated Venous Thromboembolism |
| title_full_unstemmed | Efficacy and Safety of Direct Oral Anticoagulants for Risk of Cancer-Associated Venous Thromboembolism |
| title_short | Efficacy and Safety of Direct Oral Anticoagulants for Risk of Cancer-Associated Venous Thromboembolism |
| title_sort | efficacy and safety of direct oral anticoagulants for risk of cancer associated venous thromboembolism |
| url | https://doi.org/10.1177/1076029619853629 |
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