Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in cancer patients. Low molecular weight heparin (LMWH) has been the standard of care but new guidelines have approved the use of non-vitamin K antagonist oral anticoagulants (NOAC). By conducting an individual patient data (IPD) meta-analysis of randomised controlled trials (RCTs) comparing the outcomes of NOAC versus LMWH in cancer patients, we aim to determine an ideal strategy for the prophylaxis of VTE and prevention of VTE recurrence. Three databases were searched from inception until 19 October 2022. IPD was reconstructed from Kaplan–Meier curves. Shared frailty, stratified Cox and Royston–Parmar models were fit to compare the outcomes of venous thromboembolism recurrence and major bleeding. For studies without Kaplan–Meier curves, aggregate data meta-analysis was conducted using random-effects models. Eleven RCTs involving 4844 patients were included. Aggregate data meta-analysis showed that administering NOACs led to a significantly lower risk of recurrent VTE (RR = 0.65; 95%CI: 0.50–0.84) and deep vein thrombosis (DVT) (RR = 0.60; 95%CI: 0.40–0.90). In the IPD meta-analysis, NOAC when compared with LMWH has an HR of 0.65 (95%CI: 0.49–0.86) for VTE recurrence. Stratified Cox and Royston–Parmar models demonstrated similar results. In reducing risks of recurrent VTE and DVT among cancer patients, NOACs are superior to LMWHs without increased major bleeding.
静脉血栓栓塞症是癌症患者发病和死亡的主要原因。低分子量肝素一直是标准治疗方案，但新指南已批准使用非维生素K拮抗剂口服抗凝药。通过对比较癌症患者使用NOAC与LMWH疗效的随机对照试验进行个体患者数据荟萃分析，我们旨在确定预防VTE及防止VTE复发的理想策略。我们检索了三个数据库自建库至2022年10月19日的文献。通过Kaplan-Meier曲线重建个体患者数据。采用共享脆弱模型、分层Cox模型和Royston-Parmar模型比较静脉血栓栓塞复发和大出血结局。对于未提供Kaplan-Meier曲线的研究，采用随机效应模型进行汇总数据荟萃分析。共纳入11项随机对照试验，涉及4844例患者。汇总数据荟萃分析显示，使用NOAC可显著降低VTE复发风险（RR=0.65；95%CI：0.50-0.84）和深静脉血栓形成风险（RR=0.60；95%CI：0.40-0.90）。在个体患者数据荟萃分析中，与LMWH相比，NOAC治疗VTE复发的风险比为0.65（95%CI：0.49-0.86）。分层Cox模型和Royston-Parmar模型分析结果相似。在降低癌症患者VTE复发和深静脉血栓形成风险方面，NOAC优于LMWH，且未增加大出血风险。
肿瘤(癌症)患者之家