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Journal of Thrombosis and Thrombolysis

, Volume 48, Issue 3, pp 400–412 | Cite as

Efficacy and safety of direct oral anticoagulants versus low-molecular-weight heparin in patients with cancer: a systematic review and meta-analysis

  • Ying Dong
  • Yi Wang
  • Rui-Lian Ma
  • Ming Liu
  • Jun-zhen Gao
  • Wu-yun Su
  • Li Yan
  • Jian-jun SunEmail author
Article

Abstract

The efficacy and safety of direct oral anticoagulants (DOACs) versus low-molecular-weight heparin (LMWH) are still debated in the treatment of patients with cancer, and the optimal duration of therapy remains uncertain. Electronic databases (PubMed, Embase, and Cochrane Library) were searched to retrieve studies on the efficacy and safety of DOACs versus LMWH in treating patients with cancer from January 1980 to October 2018. The primary efficacy and safety endpoints were recurrent venous thromboembolism (VTE) and major bleeding. Our study included two randomized controlled trials (RCTs) and nine observational studies, together comprising 4509 patients with cancer. The pooled estimates indicated that DOACs led to a modest reduction recurrent VTE in the RCTs [RR: 0.63, 95% confidence interval (CI), 0.42–0.96, P = 0.03] and in the observational studies (RR: 0.74, 95% CI, 0.58–0.93, P = 0.011), without increasing the risk of major bleeding for observational studies (P = 0.805), but increased for RCTs (P = 0.017). The same trends were observed in the rivaroxaban subgroup. Moreover, subgroup analyses according to the treatment duration indicated that DOACs significantly reduced the incidence of recurrent VTE (P = 0.006 at 6 months; P < 0.001 at 12 months) without significant differences in major bleeding compared with LMWH at 6 or 12 months. Patients with cancer who received DOACs exhibited a significant reduction in recurrent VTE with no increased risk of major bleeding compared with LMWH. DOACs may be an alternative choice for long-term anticoagulant therapy in patients with cancer.

Keywords

Direct oral anticoagulants Cancer Low molecular weight heparin Venous thrombo-embolism Meta-analysis 

Notes

Funding

This study was supported by grants from the Natural Science Foundation (No.81460066) of PR China, the Natural Science Foundation (No.2018MS08099) of Inner Mongolia province, Science technology millions of projects of Inner Mongolia Medical University and doctoral Sustentation Fund.

Compliance with ethical standards

Conflict of interests

All authors have nothing to disclose.

Supplementary material

11239_2019_1871_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 11 kb)
11239_2019_1871_MOESM2_ESM.docx (13 kb)
Supplementary material 2 (DOCX 12 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PharmacyAffiliated Hospital of Inner Mongolia Medical UniversityHohhotPeople’s Republic of China
  2. 2.Department of Breast SurgeryAffiliated Hospital of Inner Mongolia Medical UniversityHohhotPeople’s Republic of China
  3. 3.Department of Respiratory MedicineAffiliated Hospital of Inner Mongolia Medical UniversityHohhotPeople’s Republic of China
  4. 4.Department of Medical OncologyAffiliated Hospital of Inner Mongolia Medical UniversityHohhotPeople’s Republic of China

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