Meta-analysis of RCTs of DOACs versus LMWHs for treatment of cancer-associated venous thromboembolism

International clinical practice guidelines have progressively endorsed direct oral anticoagulants (DOACs) as alternative to low-molecular-weight heparins (LMWHs) monotherapy for initial and long-term treatment of cancer-associated thrombosis (CAT). Several recent (since 2018) have reported additional results on the safety and efficacy of DOACs in this setting. Meta-analysis of six recent randomized controlled trials (3690 patients) comparing DOACs versus LMWHs for the treatment of CAT found that DOACs versus LMWHs were associated with significantly decreased risk of CAT recurrence, with a non-significant increased risk of major bleeding, a significant increase in risk of clinically relevant nonmajor bleeding, and no difference in all-cause mortality rates. The authors conclude that these results increase the level of certainty of available evidence supporting the use of DOACs.