direct oral anticoagulants more effective than low-molecular-weight heparin for venous thrombo-embolism in cancer: an updated meta-analysis of randomized trials

In the recent past, low-molecular-weight heparin (lmwh) was the first choice in the treatment of cancer related venous thrombo-embolism (vte). evidence supporting the preferential use of direct anticoagulants (doacs) in patients with cancer, instead, is less robust so far. we therefore aimed to assess in an updated meta-analysis of randomized controlled trials whether the use of doacs be associated with a more favorable profile when compared to lmwh. we performed a meta-analysis of rcts enrolling patients with vte and cancer. we assessed mantel–haenszel pooled estimates of risk ratios (rrs) and 95% cis for recurrence of vte, major bleeding, and mortality comparing subjects treated with doacs with those with lmwh. after study selection, three rcts (hokusai-cancer, select-d and adam-vte) were included for the analysis with an overall population of 1739 patients. doacs patients had a lower incidence of 6-month recurrent vte when compared to lmwhs (rr 0.56, 95% ci 0.40–0.79; p < 0.001). incidence of major bleeding was not significantly different between doacs and lmwh treated patients (rr 1.56, 95% ci 0.95–2.47, p = n.s.), and mortality rates were comparable (rr 1.03, 95% ci 0.91–2.47, p = n.s.). in a meta-analysis of rcts therapy with doacs was superior to lmwh in terms of efficacy and lower recurrence of vte with a comparable safety profile in terms of bleeding events and complications.