Efficacy And Safety Of Oral Anticoagulants In The Prevention And Treatment Of Thrombotic Disease In Active Cancer Patients: A Meta-analysis Of Randomized Controlled Trials

Objective: To investigate the efficacy and safety of non-vitamin K antagonist oral anticoagulants(NOAC)and vitamin K antagonist(VKA)in the prevention and treatment of thrombotic diseases in patients with active cancer.Methods: To find randomized controlled trials(RCT)in which NOAC were compared VKAs in active cancer,we have searched the electronic databases(PubMed,Web of Science and Clinical Trials),no language restrictions and using a strategy up to May 2019.The cancer patients in the original literature were divided into 3 categories: patients with active cancer at enrollment,patients with active cancer after enrollment and patients with only cancer history.Data of VTE,stroke,all-cause mortality and clinically related bleeding of patients with active cancer at enrollment and after enrollment were collected respectively.The relative risk(RR)of bleeding and all-cause mortality in patients with active cancer with VTE,active cancer and non-valvular atrial fibrillation(NVAF)was calculated by comparing NOAC with VKA.Results: A total of 9 RCT articles were included,including 5 867 patients.Finally,4 019 patients with active cancer were analyzed,after excluding 1 248 patients with cancer history.In VTE patients with active cancer,NOAC in reducing recurrence of VTE [RR=0.55,95%CI:0.36~0.84;P=0.005)and clinically related non-major bleeding(CRNMB)[RR=0.77,95%CI:0.60~0.98;P=0.03] is better than VKAs.In NVAF patients with active cancer,NOAC was not significantly different from VKAs in VTE,stroke,CRNMB,MB and all-cause mortality events(P>0.05).Conclusions: For patients with active cancer accompanied by VTE or NVAF,NOAC may be an optimal choice than VKA in the prevention and treatment of thrombotic diseases.