HealthDay News — For adults with cancer-associated thrombosis (CAT), direct oral anticoagulants (DOACs) significantly reduce recurrent venous thromboembolism (VTE) events without increasing major bleeding compared with dalteparin, according to a review published online in the February issue of the Mayo Clinic Proceedings.
Irbaz Bin Riaz, MD, from the Mayo Clinic in Rochester, Minnesota, and colleagues conducted a living, interactive systematic review to examine the benefits and harms of different treatment options for adults with CAT. The analysis included randomized controlled trials evaluating the efficacy and safety of DOACs compared with low-molecular-weight heparin for CAT. Four trials with 2894 participants are currently included in the living, interactive systematic review; the results are being updated as new information becomes available.
The researchers found that compared with dalteparin, DOACs significantly reduced recurrent VTE events (odds ratio [OR], 0.59), with no significant increase in major bleeding. In mixed-treatment comparisons, apixaban and rivaroxaban significantly reduced VTE recurrent events compared to dalteparin (ORs, 0.41 and 0.58, respectively). Significant increases in major bleeding were seen with edoxaban versus dalteparin (OR, 1.73). Compared with dalteparin and other DOACs, rivaroxaban significantly increased clinically relevant nonmajor bleeding. No significant differences in VTE recurrences and major bleeding were observed between DOACs.
“DOACs should be considered a standard of care for the treatment of CAT, with caution in patients with high risk of bleeding,” the authors write.