Abstract Number: PB2179
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » Cancer Associated Thrombosis
Background: Venous thromboembolism (VTE) in patients with cancer is an important cause of morbidity and mortality and associated with a significant risk of VTE recurrence as well as bleeding associated with anticoagulation.
Aims: To compare the efficacy and safety of direct oral anticoagulants (DOACs) to standard of care in the treatment of cancer associated thrombosis (CAT).
Methods: Sytematic literature review of prospective RCTs including patients with cancer and VTE receiving DOAC: recurrent VTE as an efficacy outcome and major bleeding (MB) and clinically relevant non-major bleeding (CRNMB) as safety outcomes. Pooled incident rates and relative risks with 95% CIs calculated with The Cochrane Collaboration Review Manger 5.3 using Mantel-Haenszel random effects model.
Results: Nine RCTs identified, 3434 patients, 6 compared DOAC v LMWH/ VKA and 3 compared DOAC v LMWH. Pooled incidence rate for recurrent VTE with DOAC was 83/1734 (4.8%) versus 139/1700 (8.2%) with LMWH/VKA or LMWH a relative risk reduction of 0.30 (0.42-0.79) I2 0% p=0.03. Sub-analysis of 3 DOAC v LMWH studies 50/870 (5.7%) v 86/869 (9.9%) VTE recurrence, RR 0.50 (0.26-0.98) I2 48% p=0.04. Pooled incidence rate of MB and CRNMB with DOAC was 14.7% versus 13.7% with LMWH/VKA & LMWH alone a non-significant RR of 1.07 and similarly DOAC v LMWH 16.3% v 10.9% RR 1.58.
Conclusions: DOACs are associated with a reduced risk of recurrent VTE in patients with cancer associated thrombosis when compared to both LMWH/VKA or LMWH alone. There appears to be a non-statistically significant trend towards more bleeding with DOACs which may be related to cancer site or treatment related drug interactions. Further investigation is needed to identify patients with cancer with a low risk of bleeding who will benefit most form treatment with a DOAC.
To cite this abstract in AMA style:
Alikhan R, Rees M. Cancer Associated Thrombosis: Are DOACs a Treatment Option? Systematic Review and Meta-analysis of Randomised Controlled Trials [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/cancer-associated-thrombosis-are-doacs-a-treatment-option-systematic-review-and-meta-analysis-of-randomised-controlled-trials/. Accessed March 21, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/cancer-associated-thrombosis-are-doacs-a-treatment-option-systematic-review-and-meta-analysis-of-randomised-controlled-trials/