24 January 2022

Direct oral anticoagulants should be the standard-of-care for adults with cancer-associated thrombosis, a US study has concluded.

Scientists at the Mayo Clinic in Rochester, Minnesota, analysed the results of four randomised clinical trials involving 2,894 patients. They found that direct oral anticoagulants significantly decreased cancer-associated venous thrombosis recurrence compared with parenteral dalteparin (low molecular weight heparin).

The findings are published in Mayo Clinic Proceedings.

Drs Irbaz Riaz and Harry Fuentes Bayne from the Mayo Clinic are co-first authors of the study. Dr Riaz said: “Our meta-analysis finds that cancer patients who experience acute venous thrombosis events and were treated with direct oral anticoagulants experienced a 41% decrease in the rate of thrombosis recurrence compared with dalteparin, without significantly increasing major bleeding.”

Direct oral anticoagulants are standard-of-care to treat venous thrombosis in patients who do not have cancer, but this study shows that the same is true for cancer patients.

The review, which was led by Mayo Clinic and also involved researchers from five other institutions, did not find differences in mortality based on the use of oral anticoagulants compared with dalteparin.

However, the authors recommend caution when treating patients at high risk of bleeding.

The research continues and results will be updated when more data becomes available.

Corresponding author Dr M Hassan Murad, a clinical epidemiologist who leads Mayo clinic's evidence-based practice research program, said: “We will continue to add randomised controlled trials to this 'living' research, leading to more discoveries that produce improved outcomes for patients.”


Riaz IB, Fuentes HE, Ahmed Naqvi SA, He H, Riaz Sipra QU, Tafur AJ, Padranos L, Wysokinski WE, Marshall AL, Vandvik PO, Montori V, Bryce AH, Liu H, Badgett RG, Murad MH, McBane RD 2nd.  (2021) “Direct Oral Anticoagulants Compared With Dalteparin for Treatment of Cancer-Associated Thrombosis: A Living, Interactive Systematic Review and Network Meta-analysis.” Mayo Clinic Proceedings, doi: 10.1016/j.mayocp.2020.10.041

Link: https://www.mayoclinicproceedings.org/article/S0025-6196(20)31373-2/fulltext

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