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Clinical summary: This meta-analysis suggests that direct oral anticoagulants (DOACs) | are effective. The heterogeneity of 25% 'might not be important'.

The quality of evidence supporting benefit is moderate to high for reduction in thromboembolism, low to very low for reduction in major bleeding, and low and low for DOACS increasing clinically relevant, non-major bleeding. We included randomized controlled trials of treating patients with DOACs compared to low-molecular weight heparin for cancer-associated thrombosis. Additional interpretations may be in the references in the 'Cited by' section below.

Acknowledgement: we acknowledge the essential work by the authors of the prior systematic review(s) listed below.

Methods overview: This repository is an openMetaAnalysis that combines methods of scoping, rapid, and living systematic reviews. This analysis updates one or more previously published review(s)(1).

  Newer studies included are listed in the references. Rationale for newer trials excluded may be listed at the end of the references.

Below is the forest plot for the primary outcome. Additional Forest plots may be available. Image of forest plot of primary outcome

The Summary of Findings Table (SoF) from the GRADE Profile is below (source files). Image of GRADE Summary of findings table


Systematic review(s)

Most recent review(s) at time of last revision of this repository

  1. Fuentes HE, McBane RD, Wysokinski WE, Tafur AJ, Loprinzi CL, Murad MH | display-authors=etal. (2019). Direct Oral Factor Xa Inhibitors for the Treatment of Acute Cancer-Associated Venous Thromboembolism: A Systematic Review and Network Meta-analysis. Mayo Clin Proc, 94(12), 2444-2454. DOI: 10.1016/j.mayocp.2019.05.035 PMID: 31685262


New Studies not included in the most recent review above

  1. Agnelli G, Becattini C, Meyer G, Muñoz A, Huisman MV, Connors JM, et al. Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer. N Engl J Med. 2020 Apr 23;382(17):1599–607. PMID 32223112

Studies included in the most recent review above

  1. McBane RD 2nd, Wysokinski WE, Le-Rademacher JG, Zemla T, Ashrani A, Tafur A, et al. Apixaban and dalteparin in active malignancy-associated venous thromboembolism: The ADAM VTE trial. J Thromb Haemost. 2020 Feb;18(2):411–21. PMID 31630479 Raskob GE, van Es N, Verhamme P, Carrier M, Di Nisio M, Garcia D, et al. Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism. N Engl J Med. 2018 Feb 15;378(7):615–24. PMID 29231094 Young AM, Marshall A, Thirlwall J, Chapman O, Lokare A, Hill C, et al. Comparison of an Oral Factor Xa Inhibitor With Low Molecular Weight Heparin in Patients With Cancer With Venous Thromboembolism: Results of a Randomized Trial (SELECT-D). J Clin Oncol. 2018 Jul 10;36(20):2017–23. PMID 29746227

Studies undergoing review

  1. None

Studies excluded - selected list of important studies

  1. None

Funding for this review

  1. None.

Cited by

This repository is cited by:

  1. Riaz IB, Marshall AL, Badgett RG. In cancer-associated VTE, apixaban was noninferior to dalteparin for recurrence and did not increase major bleeding. Ann Intern Med. 2020 Aug 18;173(4):JC21. doi: 10.7326/ACPJ202008180-021. PMID: 32805168.