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• W4225269099 abstract "Abstract Background Patients with cancer-related venous thromboembolism (CA-VTE) have discovered Factor Xa inhibitors to be an effective intervention in recent decades. However, the greater bleeding risk involved with Factor Xa inhibitors than with low molecular weight heparin (LMWH) has now been substantiated in non-randomized studies as well as randomized control trials (RCT), albeit ambiguously, and this raises concerns for patients with CA-VTE. Aims We aim to pool data from all relevant studies reporting results for recurrent VTE, bleeding and mortality related to bleeding in CA-VTE patients undergoing treatment with Factor Xa inhibitors versus LMWH. Methods PubMed and Scopus databases were queried from inception through last week of March, 2022 for all RCT and non-randomized studies comparing the efficacy of Factor Xa inhibitors versus LMWH in patients with CA-VTE, on recurrence of VTE, clinically relevant non-major bleeding (CRNMB) and major bleeding events and mortality related to bleeding. A random-effects model was used and risk ratios (RR) with 95% confidence intervals (CI) were reported. Results Fourteen non-randomized studies and six RCTs were included in our analysis. The total participants were 17,781. Our pooled analysis demonstrated that in non-randomized studies, Factor Xa inhibitors, compared to LMWH, had a significantly lower risk of recurrence of VTE (RR: 0.70 [0.60, 0.80]; p = 0.00001; I2 = 0%) and a significantly higher risk of overall bleeding (RR: 1.51 [1.10, 2.07]; p = 0.01; I 2 = 59%), however, no significant difference in the risk of bleeding-related mortality was observed between Xa inhibitors and LMWH (RR: 0.99 [0.34, 2.92]; p = 0.99; I 2 = 0%). In RCTs, Factor Xa inhibitors, compared to LMWH, had a significantly lower risk of recurrence of VTE (RR: 0.65 [0.49, 0.85]; p = 0.002; I 2 = 3%) and a significantly higher risk bleeding (RR: 1.35 [1.02, 1.80]; p = 0.04; I 2 = 37%). However, no significant difference in the risk of bleeding-related mortality was observed between Factor Xa inhibitors and LMWH (RR: 0.33 [0.07, 1.43]; p = 0.14; I 2 = 0%). Furthermore, our pooled analysis demonstrated that there was no significant difference in the risk of overall bleeding in GI malignancies, between Factor Xa inhibitors and LMWH (RR: 1.39 [0.86, 2.26]; p = 0.18; I 2 = 58%), risk of CRNMB (RR: 1.52 [0.80, 2.88]; p = 0.20; I 2 = 56%), and the risk of major bleeding (RR: 1.29 [0.66, 2.48]; p = 0.46; I 2 = 46%). Conclusion Our results show that in the context of CA-VTE, Factor Xa inhibitor therapy may be a safe, effective, and realistic alternative to LMWH." @default.
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• W4225269099 date "2022-05-02" @default.
• W4225269099 modified "2023-10-16" @default.
• W4225269099 title "An Updated Systematic Review and Meta-Analysis of The Safety and Efficacy of Factor Xa Inhibitors Versus Low Molecular Weight Heparin Therapy for Treatment of Cancer Associated Venous Thromboembolism" @default.
• W4225269099 doi "https://doi.org/10.21203/rs.3.rs-1610344/v1" @default.
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