Venous thromboembolism: direct oral anticoagulants vs low-molecular-weight heparin

  • Chen H & al.
  • Medicine (Baltimore)
  • 1 Jan 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Direct oral anticoagulants (DOACs) demonstrate comparable efficacy to low-molecular-weight heparin (LMWH) in cancer patients without venous thromboembolism (VTE) with a slightly increased major bleeding occurrence rate.

Why this matter

  • DOACs are gaining popularity as an alternative strategy for the prevention of VTE in cancer patients without VTE.

Study design

  • Meta-analysis included 6 randomised controlled trials (RCTs; n=7185) after a search across Medline/PubMed and Cochrane databases.
  • Funding: None disclosed.

Key results

  • DOACs (risk ratio [RR], 0.55; 95% CI, 0.34-0.90; P=.02) and LMWH (RR, 0.59; 95% CI, 0.37-0.95; I2=59%) were equally effective in preventing VTE.
  • Bleeding occurrence rates did not differ between DOACs (RR, 1.52; 95% CI, 0.99-2.33; P=.06) and LMWH (RR, 1.35; 95% CI, 1.07-1.70; P=.01).
  • DOACs (RR, 1.95; 95% CI, 0.88-4.30; P=.10) were associated with slightly higher major bleeding occurrence rate compared with LMWH (RR, 1.38; 95% CI, 0.88-2.14; P=.16).

Limitations

  • Study did not include all relevant RCTs that evaluated the efficacy and safety of LMWH in preventing VTE.
  • Optimal duration of anticoagulation therapy was not evaluated.