Treatment of venous thromboembolism in patients with cancer: A network meta-analysis comparing efficacy and safety of anticoagulants. Issue 3 (September 2015)

• Record Type: Journal Article
• Authors: Posch, Florian; Königsbrügge, Oliver; Zielinski, Christoph; Pabinger, Ingrid; Ay, Cihan
• Is Part Of: Thrombosis research. Volume 136:Issue 3(2015)
• Page Start: 582
• Page End: 589
• Publication Date: 2015-09
• Subjects: Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2015.07.011
• Languages: English
• ISSNs: 0049-3848

Abstract

<abstract abstract-type="author" id="ab0005"> <title id="st0005">Abstract</title> <sec> <title id="st0010">Introduction</title> <p id="sp0005">Low-molecular-weight heparin (LMWH) and vitamin K antagonists (VKA) are current treatment options for cancer patients suffering from acute venous thromboembolism (VTE). The role of direct-acting oral anticoagulants (DOACs) for the treatment of VTE in cancer patients, particular in comparison with the current standard of care which is LMWH, remains unclear. In this network meta-analysis, we compared the relative efficacy and safety of LMWH, VKA, and DOAC for the treatment of cancer-associated VTE.</p> </sec> <sec> <title id="st0015">Methods</title> <p id="sp0010">A pre-specified search protocol identified 10 randomized controlled trials including 3242 cancer patients. Relative risks (RR) of recurrent VTE (efficacy) and major bleeding (safety) were analyzed using a random-effects meta-regression model.</p> </sec> <sec> <title id="st0020">Results</title> <p id="sp0015">LMWH emerged as significantly superior to VKA with respect to risk reduction of recurrent VTE (RR = 0.60, 95%CI:0.45-0.79, p < 0.001), and its safety was comparable to VKA (RR = 1.08, 95%CI:0.70-1.66, p = 0.74). For the DOAC vs. VKA efficacy and safety comparison, the relative risk estimates were in favor of DOAC, but had confidence intervals that still included equivalence (RR for recurrent VTE = 0.65, 95%CI:0.38-1.09, p = 0.10; RR for major bleeding = 0.72, 95%CI:0.39-1.37, p = 0.32). In the indirect network comparison between DOAC and LMWH, the results indicated comparable efficacy (RR = 1.08, 95%CI:0.59-1.95, p = 0.81), and a non-significant relative risk towards improved safety with DOAC (RR = 0.67, 95%CI:0.31-1.46, p = 0.31). The results prevailed after adjusting for different risk of recurrent VTE and major bleeding between LMWH vs. VKA and DOAC vs. VKA studies.</p> </sec> <sec> <title id="st0025">Conclusion</title> <p id="sp0020">The efficacy and safety of LMWH and DOACs for the treatment of VTE in cancer patients may be comparable.</p> </sec> <sec> <title id="st0085">Funding</title> <p id="sp0030">Austrian Science Fund (FWF-SFB-54)</p> </sec> </abstract>