Abstract Number: PB1111
Meeting: ISTH 2021 Congress
Background: The association of gastrointestinal (GI) cancer and a high incidence of venous thromboembolism (VTE) is well-known. Prior randomized studies demonstrated that direct oral anticoagulants (DOACs) effectively treated cancer-associated VTE (CAT). However, some DOACs appeared to increase the risk of bleeding, particularly in patients with GI malignancies. Therefore, the current systematic review and meta-analysis were conducted to evaluate the safety and efficacy of DOACs in GI cancer-associated thrombosis.
Aims: To study the efficacy and safety of DOACs vs. low-molecular-weight heparin (LMWH) for the treatment of acute VTE in patients with GI cancer.
Methods: All relevant studies that compared DOACs and LMWH in GI cancer-associated thrombosis published before December 2020 were individually searched for in two databases (MEDLINE and EMBASE) by two investigators. The effect estimates and 95% confidence intervals (CI) from each eligible study were combined using the Mantel-Haenszel method.
Results: A total of 7 eligible studies were included in this meta-analysis. Major bleeding rate was similar in both groups (OR 1.71, 95% CI, 0.93-3.14, p = 0.08, I2 = 46%). However, the clinically relevant non-major bleeding (CRNMB) rate was significantly higher in the DOACs group (OR 2.28, 95% CI: 1.45-3.59, p = 0.0004, I2 = 0%). The risk of recurrent VTE was not statistically different in both groups (OR 0.72, 95% CI: 0.40-1.29, p= 0.27, I2 = 0%).
Conclusions: Current data suggest that treatment of CAT with DOACs increased the risk of CRNMB but not major bleeding in patients with GI malignancies. The efficacy of DOACs for preventing recurrent VTE in GI cancer was similar to that of LMWH.
To cite this abstract in AMA style:Rungjirajittranon T, Owattanapanich W, Chinthammitr Y, Ruchutrakool T, Suwanawiboon B. Direct Oral Anticoagulants vs. Low-molecular-Weight Heparin for the Treatment of Acute Venous Thromboembolism Associated with Gastrointestinal Cancer: A Systematic Review and Meta-analysis [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/direct-oral-anticoagulants-vs-low-molecular-weight-heparin-for-the-treatment-of-acute-venous-thromboembolism-associated-with-gastrointestinal-cancer-a-systematic-review-and-meta-analysis/. Accessed August 19, 2022.
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