Direct-acting oral anticoagulants (DOACs) may be as safe and effective as low-molecular-weight heparins (LMWHs) in treating cancer-associated venous thromboembolism (VTE), according to a new study published in Thrombosis Research.

Researchers at the University of Perugia and the IRCCS Humanitas Research Hospital in Italy conducted a network-wide meta-analysis to assess the efficacy and safety of anticoagulants for the VTE in patients with cancer. The efficacy and safety outcomes were recurrent VTE and major bleeding, respectively.

MEDLINE and EMBASE searches were conducted through February 28, 2018; 12 studies containing 4720 patients with active cancer met the meta-analysis inclusion criteria.

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Overall, VTE recurrence occurred in 4.9% (67/1363), 9.6% (153/1590), and 8.4% (148/1767) of patients who took DOACs, vitamin K antagonists (VKAs), and LMWHs, respectively.

The following treatment combinations were compared: DOACs vs LMWHs (2 studies with 1430 patients), DOACs vs VKAs (4 studies with 1212 patients), and VKAs vs LMWHs (6 studies with 2078 patients).

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VTE recurrence was significantly higher in patients who took VKAs compared with those who took LMWHs (risk ratio [RR] 1.6, 95% CI: 1.1-2.3). No differences were seen in the other comparisons (VKAs vs DOACs, RR 1.6, 95% CI: 0.87-2.8; LMWHs vs DOACs, RR 1.6, 95% CI: 0.98-2.6).

In the network meta-analysis, patients with active cancer treated with VKAs also had  significantly higher VTE recurrence risk compared with those treated with LMWHs (RR 1.5, 95% CI: 1.1-2.0) and those treated with DOACs (RR 2.0, 95% CI: 1.3-3.0).

No significant differences in major bleeding were observed in any of the direct comparisons or in the network meta-analysis.

The authors concluded that in patients with cancer-associated venous thrombosis, “DOACs showed a good efficacy and safety profile compared to other anticoagulants.”


1. Vedovati MC, Giustozzi M, Bonitta G, Agnelli G, Becattini C. Efficacy and safety of anticoagulant agents in patients with venous thromboembolism and cancer: A network meta-analysis [published online September 1, 2018]. Thromb Res. doi: 10.1016/j.thromres.2018.08.023