Rungjirajittranon Tarinee, Owattanapanich Weerapat, Chinthammitr Yingyong, Ruchutrakool Theera, Suwanawiboon Bundarika
Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Thromb J. 2022 Jul 28;20(1):41. doi: 10.1186/s12959-022-00399-7.
The association between gastrointestinal (GI) cancer and a high incidence of venous thromboembolism (VTE) is well known. Previous randomized controlled studies demonstrated that direct oral anticoagulants (DOACs) effectively treat cancer-associated thrombosis (CAT). However, some DOACs appeared to increase the risk of bleeding, particularly in patients with GI malignancies. Therefore, the current systematic review and meta-analysis were conducted to evaluate the safety and efficacy of DOACs in GI cancer-associated thrombosis.
Two investigators individually reviewed all studies that compared DOACs and low-molecular-weight heparins (LMWHs) in GI cancer-associated thrombosis and were published in MEDLINE and EMBASE before February 2022. The effect estimates and 95% confidence intervals (CIs) from each eligible study were combined using the Mantel-Haenszel method.
A total of 2226 patients were included in the meta-analysis. The rates of major bleeding in the DOAC and LMWH groups were not significantly different (relative risk [RR]: 1.31; 95% CI: 0.84-2.04; P = 0.23; I = 41%). However, the rate of clinically relevant nonmajor bleeding (CRNMB) was significantly higher in the DOAC group (RR: 1.76; 95% CI: 1.24-2.52; P = 0.002; I = 8%). The risks of recurrent VTE in the groups did not significantly differ (RR: 0.72; 95% CI: 0.49-1.04; P = 0.08; I = 0%).
The current data suggest that treatment of GI cancer-associated thrombosis with DOACs significantly increases the risk of CRNMB. However, the risk of major bleeding was not significantly different. The efficacy of DOACs for preventing recurrent VTE in GI cancer was comparable to that of LMWHs.
INPLASY202180113 .
胃肠道（GI）癌与静脉血栓栓塞症（VTE）的高发病率之间的关联已广为人知。既往随机对照研究表明，直接口服抗凝剂（DOACs）可有效治疗癌症相关血栓形成（CAT）。然而，一些DOACs似乎会增加出血风险，尤其是在胃肠道恶性肿瘤患者中。因此，开展了本次系统评价和荟萃分析，以评估DOACs在胃肠道癌相关血栓形成中的安全性和有效性。
两名研究者分别检索了截至2022年2月发表在MEDLINE和EMBASE上的所有比较DOACs与低分子肝素（LMWHs）在胃肠道癌相关血栓形成中的研究。采用Mantel-Haenszel方法合并每项符合条件研究的效应估计值和95%置信区间（CIs）。
荟萃分析共纳入2226例患者。DOAC组和LMWH组的大出血发生率无显著差异（相对风险[RR]：1.31；95%CI：0.84-2.04；P = 0.23；I = 41%）。然而，DOAC组的临床相关非大出血（CRNMB）发生率显著更高（RR：1.76；95%CI：1.24-2.52；P = 0.002；I = 8%）。两组的复发性VTE风险无显著差异（RR：0.72；95%CI：0.49-1.04；P = 0.08；I = 0%）。
目前的数据表明，用DOACs治疗胃肠道癌相关血栓形成会显著增加CRNMB的风险。然而，大出血风险无显著差异。DOACs预防胃肠道癌复发性VTE的疗效与LMWHs相当。
INPLASY202180113 。
