Comparative Efficacy of Oral Apixaban and Subcutaneous Low Molecular Weight Heparins in the Treatment of Cancer-Associated Thromboembolism: A Meta-Analysis

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dc.authoridAl-Tawil, Mohammed/0000-0003-2111-8596
dc.authorwosidAl-Tawil, Mohammed/HOC-7828-2023
dc.contributor.authorBaloch, Maryam F.
dc.contributor.authorAdepoju, Adedimeji, V
dc.contributor.authorFalki, Vaibhavkumar
dc.contributor.authorHajjaj, Mohsin
dc.contributor.authorHabet, Tatiana
dc.contributor.authorHabet, Karina
dc.contributor.authorMahrosh, Amtul
dc.date.accessioned2024-05-19T14:46:25Z
dc.date.available2024-05-19T14:46:25Z
dc.date.issued2023
dc.departmentİstinye Üniversitesien_US
dc.description.abstractCancer patients' risk of developing venous thromboembolism (VTE) is four to seven times higher than the general population. Cancer-associated VTE (CA-VTE), is a leading cause of morbidity and mortality in cancer patients. Low Molecular Weight Heparin (LMWH) has historically been the mainstay treatment of CA-VTE; however, complications such as bleeding and recurrent VTE make it challenging to manage these patients. Recent randomized controlled trials (RCTs) have proven that direct oral anticoagulants (DOACs) are as efficacious as LMWHs in treating CA-VTE. We conducted a systematic review and meta analysis to ascertain the efficacy and safety of LMWH and Apixaban for the treatment of CA-VTE. A systematic review was conducted using Medline, Embase, and Scopus, databases for all cohort studies, case control studies, and RCTs in English comparing cancer patients undergoing treatment with Apixaban or LMWH to treat CA-VTE from inception-May 2023. The Review Manager program, version 5.4.1, was used for statistical analysis and the Mantel-Haenszel fixed-effects models to calculate the risk ratio (RR) and 95% confidence intervals (CIs) and the inverse variance approach to get the weighted mean difference for the continuous outcomes. Q-test for heterogeneity was used to examine statistical heterogeneity and an I2 statistics value >50% was defined as significant heterogeneity. A total of four studies were included, and the total number of patients was 1,632 across all studies. The Apixaban group was associated with a statistically significant increase in minor bleeding (RR 1.57; 95% CI (1.12, 2.21); p=0.009; I2=0%), but not for major and total bleeding. The Apixaban group showed a statistically significant lower risk of recurrent VTE when compared to the LMWH group (RR: 0.61; 95% CI (0.41, 0.92); p=0.02; I-2 = 7%), and there was no statistically significant difference in terms of mortality between the two groups (RR: 0.89; 95% CI (0.73, 1.09); I-2=0). Our findings suggest that Apixaban may be a favorable anticoagulant option for managing cancer-associated thromboembolism, as it demonstrated a lower risk of recurrent VTE. The risk of bleeding with DOAC in gastrointestinal cancers warrants further investigation.en_US
dc.identifier.doi10.7759/cureus.43447
dc.identifier.issn2168-8184
dc.identifier.issue8en_US
dc.identifier.pmid37711939en_US
dc.identifier.urihttps://doi.org10.7759/cureus.43447
dc.identifier.urihttps://hdl.handle.net/20.500.12713/5519
dc.identifier.volume15en_US
dc.identifier.wosWOS:001058170800025en_US
dc.identifier.wosqualityN/Aen_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.language.isoenen_US
dc.publisherSpringernatureen_US
dc.relation.ispartofCureus Journal of Medical Scienceen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.snmz20240519_kaen_US
dc.subjectRandomizeden_US
dc.subjectThromboembolismen_US
dc.subjectCanceren_US
dc.subjectLmwhen_US
dc.subjectApixabanen_US
dc.titleComparative Efficacy of Oral Apixaban and Subcutaneous Low Molecular Weight Heparins in the Treatment of Cancer-Associated Thromboembolism: A Meta-Analysisen_US
dc.typeArticleen_US

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