Title
Direct Oral Anticoagulants Compared With Dalteparin for Treatment of Cancer-Associated Thrombosis: A Living, Interactive Systematic Review and Network Meta-analysis
Date Issued
01 February 2022
Access level
metadata only access
Resource Type
journal article
Author(s)
Riaz I.B.
Fuentes H.E.
Naqvi S.A.A.
He H.
Sipra Q.u.A.R.
Tafur A.J.
Padranos L.
Wysokinski W.E.
Marshall A.L.
Vandvik P.O.
Bryce A.H.
Liu H.
Badgett R.G.
Murad M.H.
McBane R.D.
Abstract
Objective: To maintain living, interactive evidence (LIvE) on the benefits and harms of different treatment options in adults with cancer-associated thrombosis (CAT). Methods: We 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 CAT are included in this analysis. Details of LIvE synthesis framework are available at the website https://cat.network-meta-analysis.com. Results: The results are constantly updated as new information becomes available (https://cat.network-meta-analysis.com/CAT.html). The living, interactive systematic review currently includes 4 randomized controlled trials (N=2894). Direct comparisons show 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 show that apixaban (OR, 0.41; 95% credible interval [CrI], 0.16 to 0.95) and rivaroxaban (OR, 0.58; 95% CrI, 0.37 to 0.90) significantly decrease VTE recurrent events compared with dalteparin. Edoxaban significantly increases major bleeding compared with dalteparin (OR, 1.73; 95% CrI, 1.04 to 3.16), and rivaroxaban significantly increases clinically relevant nonmajor bleeding compared with dalteparin and other DOACs. There are no significant differences between DOACs in terms of VTE recurrences and major bleeding. Conclusion: DOACs should be considered a standard of care for the treatment of CAT except in patients with a high risk of bleeding. Current evidence favors the use of apixaban for the treatment of CAT among other DOACs. Registration: Open Science Framework (https://osf.io/dth86).
Start page
308
End page
324
Volume
97
Issue
2
OCDE Knowledge area
Oncología
Subjects
Scopus EID
2-s2.0-85123572945
PubMed ID
Source
Mayo Clinic Proceedings
ISSN of the container
00256196
Source funding
Bristol-Myers Squibb
Sources of information:
Directorio de Producción Científica
Scopus