Background
Venous thromboembolism (VTE) is a common cause of morbidity and mortality in cancer
patients. Until recently, guidelines recommended the use of low-molecular weight heparin
(LMWH) as standard of care for VTE in patients with cancer. Despite the proven efficacy
of direct oral anticoagulants (DOACs) for treatment of VTE, there is equipoise supporting
their use in cancer patients.
Methods
A systematic review of PubMed, Medline and EMBASE identified four randomised controlled
trials (RCTs) in patients with cancer and VTE comparing a factor Xa inhibitor (FXaI)
to LMWH. A meta-analysis was performed with a primary outcome of VTE recurrence and
key secondary outcomes of major bleeding, clinically relevant non-major bleeding (CRNMB)
and gastrointestinal (GI) bleeding.
Results
Four RCTs with 2,907 patients were included. 1,451 patients were randomised to FXaI
and 1,456 to LMWH. VTE recurrence was lower in the FXaI group (RR 0.62, 95%CI 0.44–0.87;
p=0.01; I2=24.90), with an absolute risk difference of -4% equating to a number needed to treat
of 25 for prevention of recurrent VTE with FXaI. No significant difference in major
bleeding was noted between groups (RR 1.33, 95%CI 0.84–2.11; p=0.23). Rates of GI
bleeding (RR 1.87, 95%CI 1.06–3.29; p=0.03) and CRNMB (RR 1.57, 95%CI 1.11–2.23; p=0.01)
were greater with FXaIs.
Conclusion
In patients with cancer and VTE, the rate of VTE recurrence was significantly lower
with FXaI than with LMWH without an increased risk of major bleeding. Our data supports
the use of FXaIs as the standard of care for the treatment of VTE in this population.
Keywords
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Article info
Publication history
Published online: December 09, 2021
Accepted:
October 26,
2021
Received in revised form:
October 14,
2021
Received:
November 30,
2020
Identification
Copyright
© 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
