| Institution: | 1. Mayo Clinic, Rochester, MN;2. Dow University of Health Sciences, Karachi, Pakistan;3. Banner University Medical Center, University of Arizona, Tucson, AZ;4. Pritzker School of Medicine, University of Chicago, Chicago, IL;5. Mayo Clinic, Phoenix, AZ;6. Innlandet Hospital Trust, Division Gjøvik, Norway;7. University of Kansas School of Medicine, Wichita;1. Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL;2. Advisor to residents and Consultant in General Internal Medicine, Mayo Clinic, Jacksonville, FL;1. Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China;2. Department of Pharmacy, Shenyang Pharmaceutical University, Shenyang, China;1. Mayo Clinic, Phoenix, AZ, USA;2. University of Arizona, Tucson, AZ, USA;3. Mayo Clinic, Rochester, MN, USA;4. Dow University of Health Sciences, Karachi, Pakistan;5. Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA;6. Winship Cancer Institute of Emory University, Atlanta, GA, USA;7. Holden Comprehensive Cancer Center, Iowa City, IA, USA;8. Mass General Brigham, Harvard Medical School, Boston, MA, USA;1. Internal, Vascular and Emergency Medicine – Stroke Unit, University of Perugia, Perugia, Italy;2. Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain;3. Brigham and Women''s Hospital, Hematology Division, Harvard Medical School, Boston, United States;4. Université de Paris, Service de Pneumologie et Soins Intensifs, AP-HP, Hôpital Européen Georges Pompidou, INSERM UMR-S 1140 Innovative Therapies in Haemostasis, F-75006, Paris, France;5. F-CRIN INNOVTE, F-42000, St-Etienne, France;6. Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands;7. Institute of Hematology and BMT Rambam Health Care Campus Technion, Israel Institute of Technology Haifa, Israel;8. Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI) Research Center, Milan, Italy;9. Guy''s and St. Thomas'' NHS Foundation Trust Hospital, King''s College London, London, United Kingdom |
| Abstract: | ObjectiveTo maintain living, interactive evidence (LIvE) on the benefits and harms of different treatment options in adults with cancer-associated thrombosis (CAT).MethodsWe 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.ResultsThe 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.ConclusionDOACs 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.RegistrationOpen Science Framework (https://osf.io/dth86). |
