title: Direct oral anticoagulants in patients with VTE and cancer: a systematic review and meta-analysis.
abstract: BACKGROUND
  Direct oral anticoagulants (DOAs) have been shown to be as effective and at least as safe as conventional anticoagulation for the prevention of recurrences in patients with VTE. Whether this is the case in patients with cancer-associated VTE remains undefined.
  
  
  METHODS
  We performed a meta-analysis of randomized controlled trials with the aim of assessing the efficacy and safety of DOAs in patients with VTE and cancer. MEDLINE, EMBASE, and CENTRAL were searched up to December 2013 with no language restriction. The primary outcome of the analysis was recurrent VTE. Data on major bleeding (MB) and clinically relevant nonmajor bleeding were analyzed. Data were pooled and compared by ORs and 95% CIs.
  
  
  RESULTS
  Overall, 10 studies comparing DOAs with conventional anticoagulation for treatment of VTE including patients with cancer were included in the review. Six studies were included in the meta-analysis (two with dabigatran, two with rivaroxaban, one with edoxaban, and one with apixaban), accounting for a total of 1,132 patients. VTE recurred in 23 of 595 (3.9%) and in 32 of 537 (6.0%) patients with cancer treated with DOAs and conventional treatment, respectively (OR, 0.63; 95% CI, 0.37-1.10; I2, 0%). MB occurred in 3.2% and 4.2% of patients receiving DOAs and conventional treatment, respectively (OR, 0.77; 95% CI, 0.41-1.44; I2, 0%).
  
  
  CONCLUSIONS
  DOAs seem to be as effective and safe as conventional treatment for the prevention of VTE in patients with cancer. Further clinical trials in patients with cancer-associated VTE should be performed to confirm these results.
authors.affiliation: Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Perugia, Italy. Electronic address: mcristinaved@yahoo.it.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Vedovati
authors.affiliation: Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Perugia, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Germini
authors.affiliation: Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Perugia, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
authors.affiliation: Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Perugia, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Becattini
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D000991:Antithrombins / Q000627:therapeutic use*; D065427:Factor Xa Inhibitors / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D012008:Recurrence; D054556:Venous Thromboembolism / Q000150:complications*; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D065427:Factor Xa Inhibitors; D014812:Vitamin K; D006493:Heparin