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Direct oral anticoagulant for the prevention of thrombosis in ambulatory patients with cancer: A systematic review and meta-analysis.
- Source :
-
Journal of thrombosis and haemostasis : JTH [J Thromb Haemost] 2019 Dec; Vol. 17 (12), pp. 2141-2151. Date of Electronic Publication: 2019 Sep 17. - Publication Year :
- 2019
-
Abstract
- Background: It is unclear if direct oral anticoagulant (DOAC) is efficacious and safe for prophylaxis of venous thromboembolism (VTE) in ambulatory patients with cancer.<br />Methods: We performed a systematic review using EMBASE, MEDLINE, and CENTRAL. Inclusion criteria included adult ambulatory patients with cancer, prophylactic use of DOAC, and randomized controlled trials. Exclusion criteria included pediatric patients, inpatient or postoperative setting, therapeutic indication of DOAC, or non-phase III randomized controlled trial. Two authors screened/reviewed articles and abstracted the data. Meta-analysis was performed using random-effects model. Efficacy outcome included overall and symptomatic VTE incidence during the first 6 months. Safety outcomes included major bleeding and clinically relevant non-major bleeding (CRNMB) incidence during the on-treatment period. Subgroup analysis was performed for intermediate- and high-risk Khorana score.<br />Results: A total of 202 records were identified and 28 full-text articles were assessed. Two studies with 1415 participants were included for meta-analysis. For DOAC vs placebo, the relative risks for overall and symptomatic VTE incidence by 6 months were 0.56 (0.35-0.89) and 0.58 (0.29-1.13), respectively. The relative risks for major bleeding and CRNMB while on-treatment were 1.96 (0.80-4.82) and 1.28 (0.74-2.20), respectively. Patients with high-risk Khorana score (3+) derived the largest absolute risk reduction of VTE.<br />Conclusions: Low-dose DOAC reduces the rate of overall VTE in higher risk cancer patients starting systemic chemotherapy. It may reduce the rate of symptomatic VTE but increase the likelihood of bleeding.<br /> (© 2019 International Society on Thrombosis and Haemostasis.)
- Subjects :
- Administration, Oral
Factor Xa Inhibitors adverse effects
Hemorrhage chemically induced
Humans
Incidence
Neoplasms blood
Neoplasms diagnosis
Neoplasms epidemiology
Risk Assessment
Risk Factors
Treatment Outcome
Venous Thromboembolism blood
Venous Thromboembolism diagnosis
Venous Thromboembolism epidemiology
Venous Thrombosis blood
Venous Thrombosis diagnosis
Venous Thrombosis epidemiology
Blood Coagulation drug effects
Factor Xa Inhibitors administration & dosage
Neoplasms drug therapy
Venous Thromboembolism prevention & control
Venous Thrombosis prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1538-7836
- Volume :
- 17
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Journal of thrombosis and haemostasis : JTH
- Publication Type :
- Academic Journal
- Accession number :
- 31420937
- Full Text :
- https://doi.org/10.1111/jth.14613