TY - JOUR
T1 - Efficacy and safety of novel oral anticoagulants versus low molecular weight heparin in cancer patients with venous thromboembolism: A systematic review and meta-analysis
AU - Camilli, Massimiliano
AU - Lombardi, Marco
AU - Vescovo, Giovanni Maria
AU - Del Buono, Marco Giuseppe
AU - Galli, Mattia
AU - Aspromonte, Nadia
AU - Zoccai, Giuseppe Biondi
AU - Niccoli, Giampaolo
AU - Montone, Rocco Antonio
AU - Crea, Filippo
AU - Minotti, Giorgio
PY - 2020
Y1 - 2020
N2 - Novel Oral Anticoagulants (NOACs) have been considered for treating cancer-related venous thromboembolism (VTE), but safety issues have been raised. We performed a systematic review and pairwise meta-analysis of the efficacy and safety of NOACs versus low molecular weight heparin (LMWH) in this setting. Four randomized controlled trials were included, providing data on 2894 patients. Compared to LMWH, NOACs were associated with a significantly lower risk of VTE recurrence and were not associated with an increased risk of major bleedings (MB). NOACs were non inferior to LMWH for a composite outcome of VTE recurrence and MB, pulmonary embolism recurrence and all-cause mortality; however, NOACs were associated with an increased risk of clinically relevant nonmajor bleedings (CRNMB) and gastrointestinal MB. In conclusion, in patients with cancer-related VTE, NOACs are effective and safe in reducing VTE recurrence compared to LMWH. An increased risk of CNRMB and GI MB should nonetheless be considered.
AB - Novel Oral Anticoagulants (NOACs) have been considered for treating cancer-related venous thromboembolism (VTE), but safety issues have been raised. We performed a systematic review and pairwise meta-analysis of the efficacy and safety of NOACs versus low molecular weight heparin (LMWH) in this setting. Four randomized controlled trials were included, providing data on 2894 patients. Compared to LMWH, NOACs were associated with a significantly lower risk of VTE recurrence and were not associated with an increased risk of major bleedings (MB). NOACs were non inferior to LMWH for a composite outcome of VTE recurrence and MB, pulmonary embolism recurrence and all-cause mortality; however, NOACs were associated with an increased risk of clinically relevant nonmajor bleedings (CRNMB) and gastrointestinal MB. In conclusion, in patients with cancer-related VTE, NOACs are effective and safe in reducing VTE recurrence compared to LMWH. An increased risk of CNRMB and GI MB should nonetheless be considered.
KW - Administration, Oral
KW - Anticoagulants
KW - Bleedings
KW - Cancer-related venous thromboembolism
KW - Heparin, Low-Molecular-Weight
KW - Humans
KW - Low molecular weight heparin
KW - Neoplasms
KW - Novel oral anticoagulants
KW - Personalized medicine
KW - Venous Thromboembolism
KW - Administration, Oral
KW - Anticoagulants
KW - Bleedings
KW - Cancer-related venous thromboembolism
KW - Heparin, Low-Molecular-Weight
KW - Humans
KW - Low molecular weight heparin
KW - Neoplasms
KW - Novel oral anticoagulants
KW - Personalized medicine
KW - Venous Thromboembolism
UR - http://hdl.handle.net/10807/174395
U2 - 10.1016/j.critrevonc.2020.103074
DO - 10.1016/j.critrevonc.2020.103074
M3 - Article
SN - 1040-8428
SP - 103074-N/A
JO - CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY
JF - CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY
ER -
