Direct oral anticoagulants (DOACs) are now considered the standard of care for the treatment of venous thromboembolism (VTE) in noncancer patients for several reasons. A recent study suggests that DOACs should be included in the standard of care to prevent VTE recurrence in adult cancer patients except for those with a high risk of bleeding. The study findings were published in the Mayo Clinic Proceedings on June 22, 2021.
Thrombotic outcomes increase mortality in cancer patients and are the second most common cause of death after disease progression. The data relating to DOACs for the treatment of cancer-associated thrombosis (CAT) are rapidly emerging and have challenged low-molecular-weight heparin (LMWH) as the preferred option. To further explore, researchers of Mayo Clinic conducted a study to assess the benefits and harms of different treatment options in adults with CAT using artificial intelligence (AI) technology.
In this systemic review and meta-analysis, the researchers developed an AI called LIvE synthesis framework to maintain a living, interactive systematic review since September 19, 2018. It will constantly update the results as new information becomes available. Using AI, they continually searched the literature to find a new study. Once filtering required studies, then with the guidance of experts in the field, they made some updates to their dataset. For this study, they included four randomized controlled trials (Caravaggio, ADAM VTE, SELECT D, and Hokusai VTE) and examined the data of 2,894 patients with either active cancer or a history of cancer.
Key findings of the study:
Upon analysis, the researchers found that the DOACs significantly decrease recurrent VTE events compared with dalteparin (odds ratio [OR], 0.59) without significantly increasing major bleeding (OR, 1.34).
In mixed treatment comparisons, they found that apixaban (OR, 0.41) and rivaroxaban (OR, 0.58) significantly decrease VTE recurrent events compared with dalteparin.
However, they noted that edoxaban significantly increases major bleeding compared with dalteparin (OR, 1.73), and rivaroxaban significantly increases clinically relevant nonmajor bleeding compared with dalteparin and other DOACs.
They also noted no significant differences between DOACs in terms of VTE recurrences and major bleeding.
The authors concluded, "DOACs should be considered a standard of care for the treatment of CAT except in patients with a high risk of bleeding. Current evidence favours the use of apixaban for the treatment of CAT among other DOACs."
For further information:
DOI: https://doi.org/10.1016/j.mayocp.2020.10.041