Non-Vitamin K Antagonist Oral Anticoagulants versus Low Molecular Weight Heparin for Cancer-Related Venous Thromboembolic Events: Individual Patient Data Meta-Analysis

Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in cancer patients. Low molecular weight heparin (LMWH) has been the standard of care but new guidelines have approved the use of non-vitamin K antagonist oral anticoagulants (NOAC). By conducting an individual patient data (...

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Bibliographic Details
Published in:Cancers 2023-12, Vol.15 (24), p.5887
Main Authors: Yau, Chun En, Low, Chen Ee, Ong, Natasha Yixuan, Rana, Sounak, Chew, Lucas Jun Rong, Tyebally, Sara Moiz, Chai, Ping, Yeo, Tiong-Cheng, Chan, Mark Y, Lee, Matilda Xinwei, Tan, Li-Ling, Koo, Chieh-Yang, Lee, Ainsley Ryan Yan Bin, Sia, Ching-Hui
Format: Article
Language:English
Subjects:
Analysis
Anticoagulants
Anticoagulants (Medicine)
Bleeding
Cancer
Cancer patients
Clinical trials
Disease prevention
Health aspects
Heparin
Medical diagnosis
Meta-analysis
Molecular weight
Morbidity
Oncology, Experimental
Patient compliance
Patients
Prevention
Prophylaxis
Pulmonary embolisms
Thromboembolism
Thrombosis
Veins & arteries
Vitamin K
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Summary:Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in cancer patients. Low molecular weight heparin (LMWH) has been the standard of care but new guidelines have approved the use of non-vitamin K antagonist oral anticoagulants (NOAC). By conducting an individual patient data (IPD) meta-analysis of randomised controlled trials (RCTs) comparing the outcomes of NOAC versus LMWH in cancer patients, we aim to determine an ideal strategy for the prophylaxis of VTE and prevention of VTE recurrence. Three databases were searched from inception until 19 October 2022. IPD was reconstructed from Kaplan-Meier curves. Shared frailty, stratified Cox and Royston-Parmar models were fit to compare the outcomes of venous thromboembolism recurrence and major bleeding. For studies without Kaplan-Meier curves, aggregate data meta-analysis was conducted using random-effects models. Eleven RCTs involving 4844 patients were included. Aggregate data meta-analysis showed that administering NOACs led to a significantly lower risk of recurrent VTE (RR = 0.65; 95%CI: 0.50-0.84) and deep vein thrombosis (DVT) (RR = 0.60; 95%CI: 0.40-0.90). In the IPD meta-analysis, NOAC when compared with LMWH has an HR of 0.65 (95%CI: 0.49-0.86) for VTE recurrence. Stratified Cox and Royston-Parmar models demonstrated similar results. In reducing risks of recurrent VTE and DVT among cancer patients, NOACs are superior to LMWHs without increased major bleeding.
ISSN:2072-6694
2072-6694
DOI:10.3390/cancers15245887