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Direct oral anticoagulants compared with Dalteparin for treatment of cancer-associated thrombosis


The objective of the study was to maintain living, interactive evidence ( LIvE ) on the benefits and harms of different treatment options in adults with cancer-associated thrombosis ( CAT ).

Researchers have used a novel LIvE synthesis framework to maintain this living, interactive systematic review since September 19, 2018.
Randomized controlled trials evaluating the efficacy and safety of direct oral anticoagulants ( DOACs ) compared with low-molecular-weight Heparin for cancer-associated thrombosis are included in this analysis.

The living, interactive systematic review currently includes 4 randomized controlled trials ( N=2894 ).

Direct comparisons have shown that DOACs significantly decrease recurrent venous thromboembolism ( VTE ) events compared with Dalteparin ( odds ratio [ OR ], 0.59; 95% CI, 0.41 to 0.86; I2, 25% ) without significantly increasing major bleeding ( OR, 1.34; 95% CI, 0.83 to 2.18; I2, 28% ).

Mixed treatment comparisons have shown that Apixaban [ Eliquis ] ( OR, 0.41; 95% credible interval [ CrI ], 0.16 to 0.95 ) and Rivaroxaban [ Xarelto ] ( OR, 0.58; 95% CrI, 0.37 to 0.90 ) significantly decrease venous thromboembolism recurrent events compared with Dalteparin.
Edoxaban [ Lixiana ] has significantly increased major bleeding compared with Dalteparin ( OR, 1.73; 95% CrI, 1.04 to 3.16 ), and Rivaroxaban has significantly increased clinically relevant nonmajor bleeding compared with Dalteparin and other DOACs.
There are no significant differences between DOACs in terms of venous thromboembolism recurrences and major bleeding.

In conclusion, DOACs should be considered a standard of care for the treatment of cancer-associated thrombosis except in patients with a high risk of bleeding.
Current evidence favors the use of Apixaban for the treatment of cancer-associated thrombosis among other DOACs. ( Xagena )

Riaz IB et al, Mayo Clin Proc 2022; 97: 308-324

XagenaMedicine_2022



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