Direct oral anticoagulant (DOAC) versus low-molecular-weight heparin (LMWH) for treatment of cancer associated thrombosis (CAT): A systematic review and meta-analysis.
Direct oral anticoagulant (DOAC) versus low-molecular-weight heparin (LMWH) for treatment of cancer associated thrombosis (CAT): A systematic review and meta-analysis.
复制标题
DOI：
10.1016/j.thromres.2018.02.144
复制
发表时间：
2019-01
影响因子：
7.5
通讯作者：
Carrier M
中科院分区：
文献类型：
--
作者：
Li A;Garcia DA;Lyman GH;Carrier M
目前尚不清楚直接口服抗凝剂(DOAC)是否是治疗癌症相关静脉血栓栓塞症(VTE)的低分子肝素(LMWHs)的有效和安全的替代品。我们的目标是综合现有文献，在这一高危人群中比较DOAC和低分子肝素。我们使用EMBASE、MEDLINE和CENTER对所有观察性研究和随机对照试验(RCT)进行了系统综述(PROSPERO：CRD42017080898)。两位作者独立审查了研究资格，提取了数据，并评估了偏倚。主要结果包括6个月的VTE复发和大出血。次要结果包括临床相关的非大出血(CRNMB)和死亡率。我们筛选了426篇文章，对25篇全文进行了综述，分别选择了13篇和2篇进行定性和定量综合。基于两个随机对照试验的Meta分析，DOAC的6个月复发VTE(42/725)低于LMWH(/727)(RR：0.65(0.42-1.01))。然而，DOAC的大出血(40/725)高于LMWH(23/727)(RR 1.74(1.05-2.88))。同样，接受DOAC治疗的患者CRNMB更高(RR 2.31(0.85-6.28))。死亡率差异无统计学意义(RR 1.03(0.85~1.26))。观察性研究是异质性的，有很高的偏倚风险，但显示VTE复发率与荟萃分析一致。DOAC在预防VTE复发方面比低分子肝素更有效，但与大出血风险显著增加以及CRNMB增多的趋势有关。两种主要结果的绝对风险差异很小(2-3%)，可能反映了DOAC比低分子肝素更好的依从性。
It is unclear if direct oral anticoagulants (DOACs) are effective and safe alternatives to low-molecular-weight heparin (LMWHs) for the treatment of cancer-associated venous thromboembolism (VTE). We aim to synthesize existing literature that compared DOACs versus LMWHs in this high-risk population. We conducted a systematic review using EMBASE, MEDLINE and CENTRAL for all observational studies and randomized controlled trials (RCTs) (PROSPERO: CRD42017080898). Two authors independently reviewed study eligibility, extracted data, and assessed bias. Primary outcomes included 6-month recurrent VTE and major bleeding. Secondary outcomes included clinically relevant non-major bleeding (CRNMB) and mortality. We screened 426 articles, reviewed 25 in full-text, and selected 13 and 2 for qualitative and quantitative synthesis, respectively. Based on a meta-analysis of the 2 RCTs, DOACs had lower 6-month recurrent VTE (42/725) when compared to LMWH (64/727) (RR: 0.65 (0.42–1.01)). However, DOACs had higher major bleeding (40/725) when compared to LMWH (23/727) (RR 1.74 (1.05–2.88)). Similarly, CRNMB was higher (RR 2.31 (0.85–6.28)) for patients receiving DOACs. There was no difference in mortality (RR 1.03 (0.85–1.26). Observational studies were heterogeneous with high risks of bias but showed recurrent VTE rates consistent with the meta-analysis. DOACs were more effective than LMWHs to prevent recurrent VTE but were associated with a significantly increased risk of major bleeding as well as a trend toward more CRNMB. The absolute risk differences were small (2–3%) for both primary outcomes and may reflect better compliance with DOACs than LMWHs.
登录
查看更多内容
影响因子：
7.5
作者：
Posch F;Königsbrügge O;Zielinski C;Pabinger I;Ay C
通讯作者：
Ay C
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
影响因子：
158.5
作者：
Raskob, Gary E.;van Es, Nick;Buller, Harry R.
通讯作者：
Buller, Harry R.
影响因子：
20.3
作者：
Prandoni, P;Lensing, AWA;Girolami, A
通讯作者：
Girolami, A
影响因子：
10.4
作者：
Kaatz, S.;Ahmad, D.;Schulman, S.
通讯作者：
Schulman, S.