Meta Analysis of Efficacy and Safety of Direct Oral Anticoagulants and Low-molecular-weight Heparin in the Treatment of Cancer-related Venous Thromboembolism in Patients
Objective:The aim of this study is to compare the efficacy and safety of direct oral antico-agulants(DOACs)and low-molecular-weight Heparin(LMWH)in patients with cancer-related venous throm-bosis(CAT).Methods:Databases including Pubmed,the Cochrane Library,EMBASE,CNKI,WanFang and VIP were searched for RCT and cohort studies of DOACs and LMWH in the treatment of CAT.Literature screening,data extraction and quality evaluation were conducted using the Revman 5.4.1 software for meta-analysis.Results:A total of 26 studies(7 RCT and 19 cohort studies pooled 27920 patients)were includ-ed.RCT or cohort studies,there were no statistically significant differences in major bleeding and clinical composite endpoint event between the two groups(P＞0.05);the rate of recurrent venous thromboembolism(VTE)in DOACs was lower than that in LMWH(P＜0.05),but the rate of clinically relevant non major bleeding was higher(P＜0.05).In RCT,there was no statistically significant difference in risk of all-cause mortality between the two groups(P＞0.05).In cohort studies,DOACs reduced the risk of all-cause mor-tality(P＜0.05).Subgroup analysis found that when patients with gastrointestinal cancer,although DOACs had a lower risk of recurrent VTE,it increased the risk of major bleeding;however,there was no statisti-cally significant difference in rates of recurrent VTE and major bleeding between the two groups in non gastrointestinal cancer patients.When using apixaban,the rate of recurrent VTE in LMWH was higher,while using rivaroxaban,there was no statistically significant difference in rates of recurrent VTE and major bleeding compared to LMWH.Conclusion:In CAT patients,the risk of recurrent VTE in DOACs is lower than that in LMWH,and the risk of clinically related non major bleeding is higher,but it does not in-crease the risk of major bleeding;DOACs,especially apixaban,are reasonable alternatives to LMWH,but caution should be exercised regarding the risk of major bleeding in patients with gastrointestinal cancer.
Cancer related venous thrombosisDirect oral anticoagulantsLow molecular weight hep-arinMeta analysis
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维普
