Revista Biomédica Revisada Por Pares
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Palabras clave: Direct oral anticoagulants, Thromboembolic disease, Low molecular weight heparin, cancer, Epistemonikos, GRADE
Introduction
Low molecular weight heparin is currently the standard therapy for the primary prevention of thromboembolic disease in cancer patients. The use of direct-acting anticoagulants could be an alternative, but its efficacy and safety profile in these types of patients remains unclear.
Methods
We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from identified reviews, analyzed data from primary studies, performed a meta-analysis, and prepared a summary table of results using the GRADE method.
Results and conclusions
We identified four systematic reviews that together included two primary studies, of which both correspond to trials. We conclude that the use of direct-acting oral anticoagulants probably increases the outcome of major bleeding and likely slightly increases the risk of thromboembolic disease. No studies were found that evaluated the outcome of quality of life or mortality.
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Introduction
Low molecular weight heparin is currently the standard therapy for the primary prevention of thromboembolic disease in cancer patients. The use of direct-acting anticoagulants could be an alternative, but its efficacy and safety profile in these types of patients remains unclear.
Methods
We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from identified reviews, analyzed data from primary studies, performed a meta-analysis, and prepared a summary table of results using the GRADE method.
Results and conclusions
We identified four systematic reviews that together included two primary studies, of which both correspond to trials. We conclude that the use of direct-acting oral anticoagulants probably increases the outcome of major bleeding and likely slightly increases the risk of thromboembolic disease. No studies were found that evaluated the outcome of quality of life or mortality.
Autores:
Natalia Méndez[1], Constanza Norambuena[1], Symón Silva[1], Valentín López[1,2]
Citación: Méndez N, Norambuena C, Silva S, López V. Direct acting oral anticoagulants versus low molecular weight heparin for primary thromboprophylaxis in cancer patients. Medwave 2021;21(04):e8178 doi: 10.5867/medwave.2021.04.8178
Fecha de envío: 27/10/2020
Fecha de aceptación: 1/4/2021
Fecha de publicación: 3/5/2021
Origen: No solicitado.
Tipo de revisión: Con revisión por pares externa, por dos árbitros a doble ciego.
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Khorana AA. Venous thromboembolism and prognosis in cancer. Thromb Res. 2010 Jun;125(6):490-3. | CrossRef | PubMed |Caine GJ, Stonelake PS, Lip GY, Kehoe ST. The hypercoagulable state of malignancy: pathogenesis and current debate. Neoplasia. 2002 Nov- Dec;4(6):465-73. | CrossRef | PubMed |Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost. 2007 Mar;5(3):632-4. | CrossRef | PubMed |Key NS, Khorana AA, Kuderer NM, Bohlke K, Lee AYY, Arcelus JI, et al. Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol. 2020 Feb 10;38(5):496-520. | CrossRef | PubMed |Yan YD, Zhang C, Shen L, Su YJ, Liu XY, Wang LW, et al. Net Clinical Benefit of Non-vitamin K Antagonist Oral Anticoagulants for Venous Thromboembolism Prophylaxis in Patients With Cancer: A Systematic Review and Trade-Off Analysis From 9 Randomized Controlled Trials. Front Pharmacol. 2018 Jun 12;9:575. | CrossRef | PubMed |Zeng J, Zhang X, Lip GYH, Shu X, Thabane L, Tian J, et al. Efficacy and Safety of Direct Oral Anticoagulants for Risk of Cancer-Associated Venous Thromboembolism. Clin Appl Thromb Hemost. 2019 Jan-Dec;25:1076029619853629. | CrossRef | PubMed |Sardar P, Chatterjee S, Herzog E, Pekler G, Mushiyev S, Pastori LJ, et al. New oral anticoagulants in patients with cancer: current state of evidence. Am J Ther. 2015 Nov-Dec;22(6):460-8. | CrossRef | PubMed |Franchini M, Bonfanti C, Lippi G. Cancer-associated thrombosis: investigating the role of new oral anticoagulants. Thromb Res. 2015 May;135(5):777-81. | CrossRef | PubMed |Cohen AT, Spiro TE, Büller HR, Haskell L, Hu D, Hull R, et al. Rivaroxaban for thromboprophylaxis in acutely ill medical patients. N Engl J Med. 2013 Feb 7;368(6):513-23. | CrossRef | PubMed |Goldhaber SZ, Leizorovicz A, Kakkar AK, Haas SK, Merli G, Knabb RM, et al. Apixaban versus enoxaparin for thromboprophylaxis in medically ill patients. N Engl J Med. 2011 Dec 8;365(23):2167-77. | CrossRef | PubMed |Li A, Manohar PM, Garcia DA, Lyman GH, Steuten LM. Cost effectiveness analysis of direct oral anticoagulant (DOAC) versus dalteparin for the treatment of cancer associated thrombosis (CAT) in the United States. Thromb Res. 2019 Aug;180:37-42. | CrossRef | PubMed |Mandalà M, Falanga A, Roila F; ESMO Guidelines Working Group. Management of venous thromboembolism (VTE) in cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2011 Sep;22 Suppl 6:vi85-92. | CrossRef | PubMed |Guntupalli SR, Brennecke A, Behbakht K, Tayebnejad A, Breed CA, Babayan LM, et al. Safety and Efficacy of Apixaban vs Enoxaparin for Preventing Postoperative Venous Thromboembolism in Women Undergoing Surgery for Gynecologic Malignant Neoplasm: A Randomized Clinical Trial. JAMA Netw Open. 2020 Jun 1;3(6):e207410. | CrossRef | PubMed |
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