Concomitant anticoagulants and the survival of cancer patients treated with immune checkpoint inhibitors: a meta-analysis.

Anticoagulants were suggested to influence cancer survival by possible immunomodulatory effect. However, it remained unclear if concomitant use of anticoagulants and various types of them could influence the efficacy of immune checkpoint inhibitors (ICIs) in cancer patients. Accordingly, the meta-analysis was performed to systematically evaluate the effect of concomitant anticoagulants in cancer patients receiving ICIs. Relevant studies were obtained by literature search in PubMed, Embase, and Web of Science databases. A conservative random-effect model was used to combine the results. A total of 2686 patients were enrolled, including all the patients analyzed for overall survival (OS) and 2457 patients for progression-free survival (PFS). The publication types of these 5 studies were retrospective studies. We found that concomitant use of anticoagulants significantly impaired the PFS (hazard ratio (HR): 1.29, 95% confidence interval (CI): 1.10-1.51, p = 0.002) and OS (HR:1.26, 95% CI:1.07-1.47, p = 0.004) of cancer patients receiving ICIs. Subgroup analyses showed that there was worse OS in heparin product subgroup (HR, 2.90; 95%CI: 1.71-4.92, p < 0.001). Our findings suggested that concomitant use of anticoagulants seemed to significantly impair the survival of cancer patients treated with ICIs.