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   doac compared to lmwh in the treatment of cancer related-venous thromboembolism: a systematic review and meta-analysis  
   
نویسنده mai v. ,tanguay v. f. ,guay c. a. ,bertoletti l. ,magnan s. ,turgeon a. f. ,lacasse y. ,lega j. c. ,provencher s.
منبع journal of thrombosis and thrombolysis - 2020 - دوره : 50 - شماره : 3 - صفحه:661 -667
چکیده    Low molecular weight heparins (lmwh) are the standard of care for the treatment of cancer-associated venous thromboembolism (ca-vte). we performed a systematic review and meta-analysis to compare the effects of direct oral anticoagulants (doac) versus lmwh for the treatment of ca-vte. the primary efficacy and safety outcomes were vte recurrence and major bleeding (mb). the secondary outcomes were clinically relevant non-mb (crnmb), all-cause mortality and the net clinical benefit. we searched medline, embase, central and web of science (inception- 2019) and abstracts of relevant conferences (2000–2019) to identify randomized controlled trials comparing doac and lmwh for the treatment of ca-vte. relative risks (rr) and 95% confidence intervals were estimated (mantel–haenszel method, random-effects models). a non-inferiority analysis with a margin of 1.3 for the upper boundary of the rr was conducted for the primary outcomes. from 637 references, we included four publications which encompass three trials (1756 patients). compared to lmwh, doac were associated with a trend for decreased vte recurrence (rr 0.51; 95%ci 0.25–1.03; p = 0.06; i2 = 51%), whereas mb (rr 1.64; 95%ci 1.00–2.69; p = 0.05; i2 = 0%) and crnmb (rr 1.83; 95%ci 1.04–3.20; p = 0.03; i2 = 50%) were significantly more frequent with doac. conversely, all-cause mortality (rr 1.06; 95%ci 0.83–1.35; p = 0.64; i2 = 36%) and net clinical benefit (rr 0.74; 95%ci 0.38–1.42; p = 0.36; i2 = 65%) were comparable. doac were non-inferior to lmwh in preventing ca-vte recurrence, but were associated with an increased risk of mb and crnmb. further studies are required to confirm these results and inform on the risk/benefit ratio for specific populations.
کلیدواژه bleeding ,cancer ,direct oral anticoagulant ,low molecular weight heparin ,venous thromboembolism
آدرس laval university, institut universitaire de cardiologie et de pneumologie de québec research center, canada, laval university, institut universitaire de cardiologie et de pneumologie de québec research center, canada, laval university, institut universitaire de cardiologie et de pneumologie de québec research center, canada, service de médecine vasculaire et thérapeutique, france. université jean-monnet, france, université laval, department of medicine, canada, chu de québec – université laval research centre, université laval, population health and optimal health practices research unit, canada. université laval, faculty of medicine, division of critical care medicine, department of anesthesiology and critical care medicine, canada, laval university, institut universitaire de cardiologie et de pneumologie de québec research center, canada. université laval, department of medicine, canada, university of lyon, laboratoire de biométrie et biologie evolutive, groupe d’etude multidisciplinaire des maladies thrombotiques (gemmat), france. centre hospitalier lyon sud, department of internal and vascular medicine, france, laval university, institut universitaire de cardiologie et de pneumologie de québec research center, canada. université laval, department of medicine, canada
 
     
   
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