Pulmonary vascular disease & thromboembolismMeta-analysis
Comparing Anticoagulation Strategies for Venous Thromboembolism Associated With Active Cancer
- Systematic review and network meta-analysis of randomised trials
- random-effects models
Authors' conclusion
DOACs demonstrate comparable efficacy but exhibit different safety profiles. Apixaban may confer an antithrombotic benefit without an increased risk for bleeding, distinguishing it from other contemporary anticoagulation strategies in patients with active cancer and VTE.
Study context
- Population
- Patients with active cancer and venous thromboembolism (VTE)
- Participants
- 6,623 patients · 17 RCTs
- Comparison
- DOACs vs VKA vs parenteral anticoagulation
Pooled result
As reported in the abstract
Recurrent VTE, PE and DVT among DOACs
- No significant differences among the DOACs for efficacy outcomes (recurrent VTE, PE, DVT)
Further pooled results
| Outcome | HR (95% CI) | |
|---|---|---|
| Recurrent VTE vs parenteral anticoagulation | 0.60 (0.38–0.93) | |
| 0.20.5125Hazard ratio (log scale) |
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| Major bleeding | 0.38 (0.15–0.93) | |
| CRNMB — Edoxaban vs Rivaroxaban | 0.31 (0.10–0.91) | |
| CRNMB — Rivaroxaban vs Parenteral anticoagulation | 3.76 (1.43–9.88) | |
| Major bleeding or CRNMB | 1.35 (1.02–1.79) | |
| 0.10.31310Hazard ratio (log scale) |
Major bleeding
- Apixaban similarly safe vs dabigatran and rivaroxaban
Clinically relevant nonmajor bleeding (CRNMB)
- Edoxaban similarly safe vs apixaban
Major bleeding or CRNMB
- Apixaban vs parenteral anticoagulation: no increase in bleeding
Original publication
Comparing Anticoagulation Strategies for Venous Thromboembolism Associated With Active Cancer. JACC CardioOncol. Published 9 January 2024. doi:10.1016/j.jaccao.2023.10.009
Summarised from the published abstract; every number is checked against it