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Posch, F; Königsbrügge, O; Zielinski, C; Pabinger, I; Ay, C.
Treatment of venous thromboembolism in patients with cancer: A network meta-analysis comparing efficacy and safety of anticoagulants.
Thromb Res. 2015; 136(3):582-589 Doi: 10.1016/j.thromres.2015.07.011 [OPEN ACCESS]
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Führende Autor*innen der Med Uni Graz
Posch Florian

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Low-molecular-weight heparin (LMWH) and vitamin K antagonists (VKA) are current treatment options for cancer patients suffering from acute venous thromboembolism (VTE). The role of direct-acting oral anticoagulants (DOACs) for the treatment of VTE in cancer patients, particular in comparison with the current standard of care which is LMWH, remains unclear. In this network meta-analysis, we compared the relative efficacy and safety of LMWH, VKA, and DOAC for the treatment of cancer-associated VTE. A pre-specified search protocol identified 10 randomized controlled trials including 3242 cancer patients. Relative risks (RR) of recurrent VTE (efficacy) and major bleeding (safety) were analyzed using a random-effects meta-regression model. LMWH emerged as significantly superior to VKA with respect to risk reduction of recurrent VTE (RR=0.60, 95%CI:0.45-0.79, p<0.001), and its safety was comparable to VKA (RR=1.08, 95%CI:0.70-1.66, p=0.74). For the DOAC vs. VKA efficacy and safety comparison, the relative risk estimates were in favor of DOAC, but had confidence intervals that still included equivalence (RR for recurrent VTE=0.65, 95%CI:0.38-1.09, p=0.10; RR for major bleeding=0.72, 95%CI:0.39-1.37, p=0.32). In the indirect network comparison between DOAC and LMWH, the results indicated comparable efficacy (RR=1.08, 95%CI:0.59-1.95, p=0.81), and a non-significant relative risk towards improved safety with DOAC (RR=0.67, 95%CI:0.31-1.46, p=0.31). The results prevailed after adjusting for different risk of recurrent VTE and major bleeding between LMWH vs. VKA and DOAC vs. VKA studies. The efficacy and safety of LMWH and DOACs for the treatment of VTE in cancer patients may be comparable. Austrian Science Fund (FWF-SFB-54). Copyright © 2015 Elsevier Ltd. All rights reserved.
Find related publications in this database (using NLM MeSH Indexing)
Anticoagulants - adverse effects
Anticoagulants - classification
Anticoagulants - therapeutic use
Causality -
Comorbidity -
Drug-Related Side Effects and Adverse Reactions - epidemiology
Evidence-Based Medicine -
Female -
Hemorrhage - epidemiology
Hemorrhage - etiology
Heparin, Low-Molecular-Weight - administration & dosage
Heparin, Low-Molecular-Weight - adverse effects
Humans -
Incidence -
Male -
Neoplasms - drug therapy
Neoplasms - epidemiology
Risk Assessment -
Treatment Outcome -
Venous Thromboembolism - epidemiology
Venous Thromboembolism - prevention & control
Vitamin K - antagonists & inhibitors

Find related publications in this database (Keywords)
Venous thromboembolism
Oral anticoagulants
Network meta analysis
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