Abstract
Background: An earlier systematic review reported no differences in the incidence of recurrent venous thromboembolism and major bleeding between factor Xa inhibitors and standard anticoagulation. The present meta-analysis aimed to assess the effectiveness of factor Xa inhibitors for the management of venous thromboembolism (VTE), specifically in patients with cancer, as there were more randomized clinical trials (RCTs) available. Methods: The PubMed and Cochrane Library databases were systematically screened for all RCTs assessing factor Xa inhibitor efficacy for VTE management in cancer patients. Using RevMan 5.3, we performed a Mantel-Haenszel fixed-effects meta-analysis of the following outcomes: recurrent VTE, VTE events, and major bleeding rates. Results: We identified 11 studies involving 7,965 patients. Factor Xa inhibitors were superior in preventing VTE recurrence, compared to low-molecular-weight heparin (LMWH) (OR 0.60; 95% CI 0.45-0.80; P < 0.01) and vitamin K antagonists (VKA) (OR 0.51; 95% CI 0.33-0.78; P < 0.01). As prophylaxis, factor Xa inhibitors had a similar rate of VTE compared to VKAs (OR 1.08 [95% CI 0.31-3.77]; P = 0.90) and a lower rate compared to placebo (OR 0.54 [95% CI 0.35-0.81]; P < 0.01). Major bleeding rates were higher with factor Xa inhibitors than with LMWHs (OR 1.34 [95% CI 0.83-2.18]; P = 0.23), but significantly lower than VKAs (OR 0.71 [95% CI 0.55-0.92]; P < 0.01). Conclusions: Factor Xa inhibitors are effective for VTE management in patients with cancer; however, they are also associated with an increased bleeding risk compared to LMWH, but decreased when compared to VKA.
Highlights
Cancer patients are five times more likely to experience venous thromboembolism (VTE) than the general population.[1]
According to previous clinical management recommendations, the typical VTE treatment in cancer patients involves the initial use of parenteral low-molecular-weight heparin (LMWH) followed by long-term use of oral vitamin K antagonists (VKA).[3]
Factor Xa inhibitors are preferred over LMWH and VKA because they conveniently do not require injections every day compared to LMWH, their more predictable effects, lack of monitoring or frequent repeat doses, and fewer drug interactions compared to VKA.[5]
Summary
Cancer patients are five times more likely to experience venous thromboembolism (VTE) than the general population.[1] Second only to cancer itself, VTE is the second most common cause of mortality in cancer patients.[2] According to previous clinical management recommendations, the typical VTE treatment in cancer patients involves the initial use of parenteral low-molecular-weight heparin (LMWH) followed by long-term use of oral vitamin K antagonists (VKA).[3] recent recommendations proposed factor Xa inhibitors as one of the options of the main initial treatment for VTE.[4]. Trial registry UMIN Clinical Trial Registry (UMIN ID 000040346)
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