Facultad de Ciencias de la Salud, Universidad Cientifica del Sur, Lima 15067, Peru.
Cancer Research Networking, Universidad Cientifica del Sur, Lima 15067, Peru.
Medicina (Kaunas). 2023 Oct 20;59(10):1867. doi: 10.3390/medicina59101867.
: Venous thromboembolism (VTE) is common in cancer patients. Anticoagulant therapy with low-molecular-weight heparins (LMWHs) and direct oral anticoagulants (DOACs), such as dalteparin and apixaban, have demonstrated efficacy and safety. However, more comparative research of these drugs is still needed. This study aimed to synthesize evidence on the efficacy of apixaban compared to dalteparin in reducing recurrent VTE, major bleeding, and clinically relevant non-major bleeding associated with cancer. : We systematically searched the PubMed, Scopus, Web of Science, Embase, Cochrane Library, and ClinicalTrials databases up to 5 January 2023, for randomized controlled trials comparing apixaban versus dalteparin as treatment for cancer-associated VTE. Five studies were included. Effects according to meta-analyses were reported as relative risks (RRs) and their 95% confidence intervals (CIs). : It was found that 33 of 734 (4.5%) patients treated with apixaban and 56 of 767 (7.3%) with dalteparin had recurrent VTE as the efficacy outcome (RR 0.49, 95% CI 0.15-1.58, I 38%). Major bleeding occurred in 25 of 734 patients treated with apixaban (3.4%) and 27 of 767 with dalteparin (3.5%) (RR 1.29, 95% CI 0.31-5.27, I 59%). Likewise, clinically relevant non-major bleeding occurred in 64 of 734 patients treated with apixaban (8.7%) and 46 of 767 (5.9%) with dalteparin (RR 1.52, 95% CI 1.05-2.19, I 0%). : Apixaban showed a lower risk of recurrent VTE than dalteparin in patients with cancer-associated VTE, albeit with no statistical difference. Statistical significance was observed for no major clinically relevant bleeding but not for major bleeding.
静脉血栓栓塞症（VTE）在癌症患者中很常见。低分子量肝素（LMWH）和直接口服抗凝剂（DOAC）如达肝素和阿哌沙班的抗凝治疗已证明具有疗效和安全性。然而，仍需要更多这些药物的比较研究。本研究旨在综合阿哌沙班与达肝素在降低与癌症相关的 VTE 复发、大出血和临床相关非大出血方面的疗效证据。
我们系统地检索了 PubMed、Scopus、Web of Science、Embase、Cochrane 图书馆和临床试验数据库，截至 2023 年 1 月 5 日，以查找比较阿哌沙班与达肝素治疗癌症相关 VTE 的随机对照试验。共纳入了 5 项研究。根据荟萃分析报告的效应为相对风险（RR）及其 95%置信区间（CI）。
结果发现，接受阿哌沙班治疗的 734 例患者中有 33 例（4.5%）和接受达肝素治疗的 767 例患者中有 56 例（7.3%）出现 VTE 复发（RR 0.49，95%CI 0.15-1.58，I 38%）。接受阿哌沙班治疗的 734 例患者中有 25 例（3.4%）和接受达肝素治疗的 767 例患者中有 27 例（3.5%）发生大出血（RR 1.29，95%CI 0.31-5.27，I 59%）。同样，接受阿哌沙班治疗的 734 例患者中有 64 例（8.7%）和接受达肝素治疗的 767 例患者中有 46 例（5.9%）发生临床相关非大出血（RR 1.52，95%CI 1.05-2.19，I 0%）。
阿哌沙班在癌症相关 VTE 患者中的 VTE 复发风险低于达肝素，但无统计学差异。对于无大出血的主要临床相关出血无统计学意义，但对于大出血有统计学意义。
