Other Titles
Efficacy of Direct Oral Anticoagulants versus Low-Molecular-Weight Heparin for Acute Venous Thromboembolism in Cancer Patients: A Meta-Analysis [Poster Title]
Abstract
Background: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant cause of morbidity and mortality in cancer patients, with an incidence rate 4 to 7 times higher than in the general population. This increased risk is linked to cancer and its treatments. Low-molecular-weight heparin (LMWH) has been the traditional treatment for cancer-related VTE, but subcutaneous administration presents adherence challenges. Direct Oral Anticoagulants (DOACs), such as dabigatran, rivaroxaban, apixaban, and edoxaban, have emerged as alternatives with oral administration, predictable pharmacodynamics, and no need for regular monitoring. This meta-analysis assesses the efficacy and safety of DOACs compared to LMWH in treating cancer-associated VTE.
Methods: A comprehensive literature search was conducted in PubMed, CINAHL, and CENTRAL, concluding in July 2024. Studies comparing DOACs and LMWH for cancer-associated VTE were included. The primary outcomes were recurrent VTE and major bleeding events at 6 months. A random-effects model was used to account for differences in drug types, dosages, and baseline risk factors. Results were presented as relative risk ratios (RRs) with 95% confidence intervals (CIs). Meta-analysis was performed using R software, with evidence graded according to the GRADE framework.
Results: Five randomized controlled trials with 3,532 participants were analyzed. Of these, 1,776 patients received DOACs and 1,756 received LMWH. The analysis found that for every 100 patients treated with DOACs, there were 2.77 fewer VTE recurrences (RR 0.66, 95% CI 0.52; 0.85). However, DOACs were associated with 0.68 more major bleeding events (RR 1.2, 95% CI 0.85; 1.71). Approximately 36 patients need to be treated with DOACs to prevent one VTE recurrence, while 147 patients need to be treated for one additional major bleeding event. Treating 100 patients with DOACs saves about NT$7,444 per day compared to LMWH.
Conclusions: DOACs are effective in preventing VTE recurrences, with one event prevented for every 36 patients treated. The risk of major bleeding is relatively low, with one additional event per 147 patients treated. DOACs are more cost-effective, costing NT$55.8 per day, and patients prefer oral administration over injections. Education on monitoring for abnormal bleeding, such as melena, hematuria, or hemoptysis, is essential during treatment.
Notes
References:
1.GIUSTOZZI, Michela, et al. Direct oral anticoagulants for the treatment of acute venous thromboembolism associated with cancer: a systematic review and meta-analysis. Thrombosis and haemostasis, 2020, 120.07: 1128-1136.
2.SCHRAG, Deborah, et al. Direct oral anticoagulants vs low-molecular-weight heparin and recurrent VTE in patients with cancer: a randomized clinical trial. Jama, 2023, 329.22: 1924-1933.
Sigma Membership
Lambda Beta at-Large
Type
Poster
Format Type
Text-based Document
Study Design/Type
Meta-Analysis/Synthesis
Research Approach
Other
Keywords:
Acute Care, Venous Thromboembolism, VTE, Cancer Patients
Recommended Citation
Mei, Sung Chien; Wen, Ou Ya; and Chi, Chao Li, "Efficacy of DOACs vs. LMWH for Cancer-Associated Acute Venous Thromboembolism: A Meta-Analysis" (2025). International Nursing Research Congress (INRC). 40.
https://www.sigmarepository.org/inrc/2025/posters_2025/40
Conference Name
36th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Seattle, Washington, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Efficacy of DOACs vs. LMWH for Cancer-Associated Acute Venous Thromboembolism: A Meta-Analysis
Seattle, Washington, USA
Background: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant cause of morbidity and mortality in cancer patients, with an incidence rate 4 to 7 times higher than in the general population. This increased risk is linked to cancer and its treatments. Low-molecular-weight heparin (LMWH) has been the traditional treatment for cancer-related VTE, but subcutaneous administration presents adherence challenges. Direct Oral Anticoagulants (DOACs), such as dabigatran, rivaroxaban, apixaban, and edoxaban, have emerged as alternatives with oral administration, predictable pharmacodynamics, and no need for regular monitoring. This meta-analysis assesses the efficacy and safety of DOACs compared to LMWH in treating cancer-associated VTE.
Methods: A comprehensive literature search was conducted in PubMed, CINAHL, and CENTRAL, concluding in July 2024. Studies comparing DOACs and LMWH for cancer-associated VTE were included. The primary outcomes were recurrent VTE and major bleeding events at 6 months. A random-effects model was used to account for differences in drug types, dosages, and baseline risk factors. Results were presented as relative risk ratios (RRs) with 95% confidence intervals (CIs). Meta-analysis was performed using R software, with evidence graded according to the GRADE framework.
Results: Five randomized controlled trials with 3,532 participants were analyzed. Of these, 1,776 patients received DOACs and 1,756 received LMWH. The analysis found that for every 100 patients treated with DOACs, there were 2.77 fewer VTE recurrences (RR 0.66, 95% CI 0.52; 0.85). However, DOACs were associated with 0.68 more major bleeding events (RR 1.2, 95% CI 0.85; 1.71). Approximately 36 patients need to be treated with DOACs to prevent one VTE recurrence, while 147 patients need to be treated for one additional major bleeding event. Treating 100 patients with DOACs saves about NT$7,444 per day compared to LMWH.
Conclusions: DOACs are effective in preventing VTE recurrences, with one event prevented for every 36 patients treated. The risk of major bleeding is relatively low, with one additional event per 147 patients treated. DOACs are more cost-effective, costing NT$55.8 per day, and patients prefer oral administration over injections. Education on monitoring for abnormal bleeding, such as melena, hematuria, or hemoptysis, is essential during treatment.
Description
This meta-analysis evaluates the efficacy and safety of DOACs versus LMWH for cancer-associated VTE treatment. DOACs prevent one VTE recurrence for every 36 patients treated, while one additional major bleeding event occurs for every 147 patients. DOACs are more cost-effective at NT$55.8 per day and preferred for their oral administration. It is essential to educate patients to monitor for abnormal bleeding, such as melena, hematuria, hemoptysis, or persistent epistaxis.