Efficacy and safety of novel oral anticoagulants versus low molecular weight heparin in cancer patients with venous thromboembolism: A systematic review and meta-analysis

Massimiliano Camilli; Marco Lombardi; Giovanni Maria Vescovo; Marco Giuseppe Del Buono; Mattia Galli; Nadia Aspromonte; Giuseppe Biondi Zoccai; Giampaolo Niccoli; Rocco A Montone; Filippo Crea; Giorgio Minotti

doi:10.1016/j.critrevonc.2020.103074

Efficacy and safety of novel oral anticoagulants versus low molecular weight heparin in cancer patients with venous thromboembolism: A systematic review and meta-analysis

Crit Rev Oncol Hematol. 2020 Oct:154:103074. doi: 10.1016/j.critrevonc.2020.103074. Epub 2020 Aug 2.

Affiliations

¹ Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.
² Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
³ Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁴ Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy.
⁵ Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁶ Department of Medicine, Center for Integrated Research and Unit of Drug Sciences, University Campus Bio-Medico, Rome, Italy. Electronic address: g.minotti@unicampus.it.

PMID: 32911455
DOI: 10.1016/j.critrevonc.2020.103074

Abstract

Novel Oral Anticoagulants (NOACs) have been considered for treating cancer-related venous thromboembolism (VTE), but safety issues have been raised. We performed a systematic review and pairwise meta-analysis of the efficacy and safety of NOACs versus low molecular weight heparin (LMWH) in this setting. Four randomized controlled trials were included, providing data on 2894 patients. Compared to LMWH, NOACs were associated with a significantly lower risk of VTE recurrence and were not associated with an increased risk of major bleedings (MB). NOACs were non inferior to LMWH for a composite outcome of VTE recurrence and MB, pulmonary embolism recurrence and all-cause mortality; however, NOACs were associated with an increased risk of clinically relevant nonmajor bleedings (CRNMB) and gastrointestinal MB. In conclusion, in patients with cancer-related VTE, NOACs are effective and safe in reducing VTE recurrence compared to LMWH. An increased risk of CNRMB and GI MB should nonetheless be considered.

Keywords: Bleedings; Cancer-related venous thromboembolism; Low molecular weight heparin; Novel oral anticoagulants; Personalized medicine.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Administration, Oral
Anticoagulants / adverse effects
Anticoagulants / therapeutic use
Heparin, Low-Molecular-Weight / adverse effects
Heparin, Low-Molecular-Weight / therapeutic use
Humans
Neoplasms / complications*
Neoplasms / drug therapy*
Venous Thromboembolism / drug therapy*
Venous Thromboembolism / etiology*

Substances

Anticoagulants
Heparin, Low-Molecular-Weight