Evidence map›Paper›PMID 29506866›Full record

SynthesisThrombosis research2019

Direct oral anticoagulant (DOAC) versus low-molecular-weight heparin (LMWH) for treatment of cancer associated thrombosis (CAT): A systematic review and meta-analysis.

Ang Li, David A Garcia, Gary H Lyman, Marc Carrier

Open access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Thrombosis research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 129 papers, 25 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
129citing papers in PubMed, 25 pooled it
34.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

129 citing papers in PubMed, 25 syntheses or guidelines pooled it, 281 citations in OpenAlex.

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  8. Direct oral anticoagulants for venous thromboembolism in cancer patients: a systematic review and network meta-analysis.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2022
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  13. Brazilian Cardio-oncology Guideline - 2020.Arquivos brasileiros de cardiologia · 2020
    Guideline
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  18. SEOM clinical guideline of venous thromboembolism (VTE) and cancer (2019).Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2020
    Guideline
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69 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors at 3 institutions in 2 countries.

Ang LiDivision of Hematology, University of Washington School of Medicine, Seattle, WA, United States. Electronic address: ali2015@uw.edu.
David A GarciaDivision of Hematology, University of Washington School of Medicine, Seattle, WA, United States.
Gary H LymanDivisions of Public Health Sciences and Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, United States; Division of Medical Oncology, University of Washington School of Medicine, Seattle, WA, United States.
Marc CarrierClinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
University of Washington · USOttawa Hospital · CAUniversity of Washington Medical Center · US

Funding

RESEARCH TRAINING IN HEMATOLOGYT32HL007093 · NHLBI · UNIVERSITY OF WASHINGTON · PI Janis L Abkowitz · 1985 to 2026
$13.9M
NHLBI NIH HHS T32 HL007093
6 · The paper itself

Abstract

introductionIt is unclear if direct oral anticoagulants (DOACs) are effective and safe alternatives to low-molecular-weight heparin (LMWHs) for the treatment of cancer-associated venous thromboembolism (VTE). We aim to synthesize existing literature that compared DOACs versus LMWHs in this high-risk population. MATERIALS AND

methodsWe conducted a systematic review using EMBASE, MEDLINE and CENTRAL for all observational studies and randomized controlled trials (RCTs) (PROSPERO: CRD42017080898). Two authors independently reviewed study eligibility, extracted data, and assessed bias. Primary outcomes included 6-month recurrent VTE and major bleeding. Secondary outcomes included clinically relevant non-major bleeding (CRNMB) and mortality.

resultsWe screened 426 articles, reviewed 25 in full-text, and selected 13 and 2 for qualitative and quantitative synthesis, respectively. Based on a meta-analysis of the 2 RCTs, DOACs had lower 6-month recurrent VTE (42/725) when compared to LMWH (64/727) (RR: 0.65 (0.42-1.01)). However, DOACs had higher major bleeding (40/725) when compared to LMWH (23/727) (RR 1.74 (1.05-2.88)). Similarly, CRNMB was higher (RR 2.31 (0.85-6.28)) for patients receiving DOACs. There was no difference in mortality (RR 1.03 (0.85-1.26)). Observational studies were heterogeneous with high risks of bias but showed recurrent VTE rates consistent with the meta-analysis.

conclusionsDOACs were more effective than LMWHs to prevent recurrent VTE but were associated with a significantly increased risk of major bleeding as well as a trend toward more CRNMB. The absolute risk differences were small (2-3%) for both primary outcomes and may reflect better compliance with DOACs than LMWHs.

Indexed as

Administration, OralAnticoagulantsHemorrhageHeparin, Low-Molecular-WeightHumansNeoplasmsSecondary PreventionThrombosisVenous ThromboembolismAnticoagulantsHeparin, Low-Molecular-WeightFactor Xa inhibitorsHeparinLow-molecular-weightNeoplasmsVenous thrombosis

Identifiers

PMID29506866
PMCPMC6119655
OpenAlexW2792485334

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.