New Direct Oral Anticoagulants for Cancer-Associated VTE: How Effective?

Allan S. Brett, MD reviewing Vedovati MC et al. Chest 2015 Feb.

These drugs appear to be comparable to warfarin in patients with cancer-associated venous thromboembolism.

For treating venous thromboembolism (VTE) in patients with active cancer, guidelines from the American College of Chest Physicians express a preference for low-molecular-weight heparin over vitamin K antagonists (Chest 2012; 141(2 Suppl):e419S); however, this recommendation is graded 2B (weak recommendation, moderate-quality evidence). Now, researchers have conducted a meta-analysis to determine the efficacy of the new direct oral anticoagulants (DOACs; dabigatran [Pradaxa], rivaroxaban [Xarelto], apixaban [Eliquis], and edoxaban [Savaysa]) in such patients.

In six studies of patients with VTE who received vitamin K antagonists (usually warfarin) or DOACs, researchers specifically reported results for subgroups of patients with active cancer. Incidence of VTE recurrence in these 1132 patients was 4% with DOACs and 6% with vitamin K antagonists — a nonsignificant difference. Major bleeding and clinically relevant bleeding also were slightly, but nonsignificantly, less common with DOACs than with vitamin K antagonists.

Citation(s):

Vedovati MC et al. Direct oral anticoagulants in patients with VTE and cancer: A systematic review and meta-analysis. Chest 2015 Feb; 147:475.