TY - JOUR
T1 - Direct Oral Anticoagulants Compared With Dalteparin for Treatment of Cancer-Associated Thrombosis
T2 - A Living, Interactive Systematic Review and Network Meta-analysis
AU - Riaz, Irbaz Bin
AU - Fuentes, Harry E.
AU - Naqvi, Syed Arsalan Ahmed
AU - He, Huan
AU - Sipra, Qurat ul Ain Riaz
AU - Tafur, Alfonso J.
AU - Padranos, Leslie
AU - Wysokinski, Waldemar E.
AU - Marshall, Ariela L.
AU - Vandvik, Per Olav
AU - Montori, Victor
AU - Bryce, Alan H.
AU - Liu, Hongfang
AU - Badgett, Robert G.
AU - Murad, Mohammad Hassan
AU - McBane, Robert D.
N1 - Funding Information:
Potential Competing Interests: Robert D. McBane 2nd declares research funding from Bristol-Myers Squibb related to the EVE trial. All the other authors have no conflicts of interest to declare.
Publisher Copyright:
© 2020 Mayo Foundation for Medical Education and Research
PY - 2022/2
Y1 - 2022/2
N2 - Objective: To maintain living, interactive evidence (LIvE) on the benefits and harms of different treatment options in adults with cancer-associated thrombosis (CAT). Methods: We have used a novel LIvE synthesis framework to maintain this living, interactive systematic review since September 19, 2018. Randomized controlled trials evaluating the efficacy and safety of direct oral anticoagulants (DOACs) compared with low-molecular-weight heparin for CAT are included in this analysis. Details of LIvE synthesis framework are available at the website https://cat.network-meta-analysis.com. Results: The results are constantly updated as new information becomes available (https://cat.network-meta-analysis.com/CAT.html). The living, interactive systematic review currently includes 4 randomized controlled trials (N=2894). Direct comparisons show that DOACs significantly decrease recurrent venous thromboembolism (VTE) events compared with dalteparin (odds ratio [OR], 0.59; 95% CI, 0.41 to 0.86; I2, 25%) without significantly increasing major bleeding (OR, 1.34; 95% CI, 0.83 to 2.18; I2, 28%). Mixed treatment comparisons show that apixaban (OR, 0.41; 95% credible interval [CrI], 0.16 to 0.95) and rivaroxaban (OR, 0.58; 95% CrI, 0.37 to 0.90) significantly decrease VTE recurrent events compared with dalteparin. Edoxaban significantly increases major bleeding compared with dalteparin (OR, 1.73; 95% CrI, 1.04 to 3.16), and rivaroxaban significantly increases clinically relevant nonmajor bleeding compared with dalteparin and other DOACs. There are no significant differences between DOACs in terms of VTE recurrences and major bleeding. Conclusion: DOACs should be considered a standard of care for the treatment of CAT except in patients with a high risk of bleeding. Current evidence favors the use of apixaban for the treatment of CAT among other DOACs. Registration: Open Science Framework (https://osf.io/dth86).
AB - Objective: To maintain living, interactive evidence (LIvE) on the benefits and harms of different treatment options in adults with cancer-associated thrombosis (CAT). Methods: We have used a novel LIvE synthesis framework to maintain this living, interactive systematic review since September 19, 2018. Randomized controlled trials evaluating the efficacy and safety of direct oral anticoagulants (DOACs) compared with low-molecular-weight heparin for CAT are included in this analysis. Details of LIvE synthesis framework are available at the website https://cat.network-meta-analysis.com. Results: The results are constantly updated as new information becomes available (https://cat.network-meta-analysis.com/CAT.html). The living, interactive systematic review currently includes 4 randomized controlled trials (N=2894). Direct comparisons show that DOACs significantly decrease recurrent venous thromboembolism (VTE) events compared with dalteparin (odds ratio [OR], 0.59; 95% CI, 0.41 to 0.86; I2, 25%) without significantly increasing major bleeding (OR, 1.34; 95% CI, 0.83 to 2.18; I2, 28%). Mixed treatment comparisons show that apixaban (OR, 0.41; 95% credible interval [CrI], 0.16 to 0.95) and rivaroxaban (OR, 0.58; 95% CrI, 0.37 to 0.90) significantly decrease VTE recurrent events compared with dalteparin. Edoxaban significantly increases major bleeding compared with dalteparin (OR, 1.73; 95% CrI, 1.04 to 3.16), and rivaroxaban significantly increases clinically relevant nonmajor bleeding compared with dalteparin and other DOACs. There are no significant differences between DOACs in terms of VTE recurrences and major bleeding. Conclusion: DOACs should be considered a standard of care for the treatment of CAT except in patients with a high risk of bleeding. Current evidence favors the use of apixaban for the treatment of CAT among other DOACs. Registration: Open Science Framework (https://osf.io/dth86).
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U2 - 10.1016/j.mayocp.2020.10.041
DO - 10.1016/j.mayocp.2020.10.041
M3 - Article
C2 - 34172290
AN - SCOPUS:85123572945
SN - 0025-6196
VL - 97
SP - 308
EP - 324
JO - Mayo Clinic Proceedings
JF - Mayo Clinic Proceedings
IS - 2
ER -