OBJECTIVE To systematically evaluate the efficacy and safety of novel oral anticoagulants(NOAC)in the treatment of cancer-related venous thromboembolism(VTE)patients.METHODS Retrieved from PubMed,Cochrane Library,Embase,Web of Science,CNKI,and Wanfang database from the establishment of each database to August,2023,randomized controlled trials(RCTs)about the efficacy of low-molecular-weight heparin(LMWH,control group)versus NOAC(trial group)in the treatment of cancer-related VTE patients were collected.After extracting the data from included clinical studies,meta-analysis was performed by using RevMan 5.0 statistical software.RESULTS A total of 7 RCTs were included,with a total of 3 790 patients.Compared with the control group,the recurrence rate of VTE in the trial group was significantly reduced(RR=0.65,95%CI 0.51-0.82,P=0.000 4),while the incidence of major bleeding was slightly higher than in the control group,but the difference was not statistically significant(RR=1.13,95%CI 0.83-1.53,P=0.45).The incidence of clinically relevant non-major bleeding(RR=1.69,95%CI 1.34-2.13,P＜0.000 01)and gastrointestinal bleeding(RR=1.96,95%CI 1.15-3.34,P=0.01)in the trial group was significantly higher than in the control group.There was no statistically significant difference in the incidence of intracranial hemorrhage,all-cause mortality,and fatal pulmonary embolism between 2 groups(P＞0.05).CONCLUSIONS For cancer-related VTE patients,NOAC is superior to LMWH in preventing venous thrombosis recurrence,and is not inferior to LMWH in terms of major bleeding,intracranial hemorrhage,all-cause mortality,and fatal pulmonary embolism.
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