Efficacy of Direct Oral Anticoagulants for the Treatment of Cancer-Associated Thrombosis: A Systematic Review

Abstract

Introduction: Cancer-associated thrombosis (CAT) is a common complication of malignancy. Low-molecular-weight heparin (LMWH) has been the standard of care. This review evaluates the efficacy and safety of direct oral anticoagulants (DOACs) in this setting.

Methods: A search of MEDLINE and CENTRAL was conducted for RCTs comparing a DOAC (e.g., edoxaban, rivaroxaban, apixaban) to LMWH for the treatment of acute VTE in patients with active cancer. The primary outcome was recurrent VTE.

Results: The meta-analysis of five RCTs showed that DOACs were non-inferior to LMWH in preventing recurrent VTE. However, the risk of major bleeding, particularly gastrointestinal bleeding, was higher with DOACs in patients with luminal GI cancers. The risk of clinically relevant non-major bleeding was also increased.

Discussion: DOACs offer a convenient oral alternative to LMWH for CAT treatment, but their use requires careful patient selection. Patients with gastrointestinal malignancies may be better candidates for LMWH due to the increased bleeding risk with DOACs.

Conclusion: DOACs are effective in treating cancer-associated thrombosis but are associated with a higher risk of bleeding compared to LMWH.