Abstract 15340: New Oral Anticoagulants in Patients With Cancer: Evidence From a Meta-analysis of Randomized Trials
Background: Effectiveness of new oral anticoagulants in patients with cancer is not clearly defined. There remain concerns of doubtful benefit and chances of potential harm with newer agents. In this meta-analysis, we evaluated the efficacy and safety on NOAC in patients with cancer.
Methods: PubMed, Cochrane Library, EMBASE, Web of Science and CINAHL databases were searched from January 01, 2001 through February 28, 2013. Randomized controlled trials (RCTs) reporting efficacy and safety data of NOACs (rivaroxaban, dabigatran and apixaban) with control (Low molecular weight heparin/vitamin K antagonists/placebo) for patients with cancer were included. Primary efficacy outcome was venous thromboembolism (VTE) or VTE related death, and primary safety outcome was clinically relevant bleeding. We used random-effects models.
Results: Six trials randomized total 19,832 patients and 1,197 patients had cancer. Risk of VTE or VTE related death was not significantly different with NOAC compared to control (odds ratio 0,80, 95% CI 0.39-1.65) in patients with cancer. Separate analysis for individual effects, showed similar results for rivaroxaban (OR1.08, 95%CI 0.60-1.94) and dabigatran (OR 0.91, 95%CI 0.21-3.91). Clinically relevant bleeding was not higher with NOAC compared to control (OR 1.49, 95% CI 0.82-2.71); individual effect of rivaroxaban showed similar result. No statistically significant difference of efficacy and safety with NOAC was found between patient with cancer and patients without cancer.
Conclusions: Rivaroxaban might be equally effective and safe as vitamin K antagonist/LMWH in patients with cancer. Dabigatran is as effective as comparator; however safety profile of dabigatran is unknown. Randomized trials of new anticoagulants specific to the cancer population are necessary.
- © 2013 by American Heart Association, Inc.