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Use of a DOAC if deep vein thrombosis (DVT) and cancer

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Direct oral anticoagulants (DOACs) have a similar efficacy profile compared to subcutaneous injected low-molecular-weight-heparin (LMWH) in patients treated for cancer-associated thrombosis (CAT) (1)

  • subanalysis of the Caravaggio study compared the sites of major and clinically relevant non-major bleeding (CRNMB) events, associated cancer sites, clinical presentation, and course of major bleeding in patients with CAT receiving either the DOAC apixaban or the LMWH dalteparin (2)
  • major bleeding was present in 3.8% of patients with apixaban and in 4.0% in those treated with dalteparin (HR 0.82, 95%CI: 0.40-1.69) (3)

The study authors concluded that the number of bleedings as well as the clinical presentation and course of major bleeding events in patients treated for CAT were similar in the apixaban and dalteparin treatment groups. These findings were consistent across various cancers, including different gastrointestinal tumor types.

A living, interactive systematic review and network meta-analysis which includes randomized controlled trials (RCTs) evaluated the efficacy and safety of direct DOACs compared with low-molecular-weight heparin (LMWH) in patients with CAT

  • DOACs decreased recurrent VTE events compared with dalteparin in patients with CAT (3)
    • was no difference between DOACs and dalteparin with regard to major bleedings
    • DOACs were associated with increased rates of clinically relevant non-major bleeding compared to dalteparin
    • "...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..."

RCT (n=604) found that edoxaban treatment for 12 months was superior to 3 months in this population with respect to the composite outcome of a symptomatic recurrent VTE or VTE-related death (1% vs 7.2% in the 12 vs 3-month groups, (OR 0.13; 95% CI, 95% CI 0.03-0.44) (4)


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