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Background <p>Cancer-associated thrombosis is a condition associated with high mortality rates, yet limited evidence exists regarding the safety and effectiveness of low-molecular-weight heparin (LMWH) and direct oral anticoagulants (DOACs), focusing on a fixed follow-up period based on clinical practice guideline recommendations.</p> Objective <p>This study aimed to compare the safety and effectiveness of DOACs versus LMWH in patients with cancer-associated thrombosis over a 6-month follow-up period.</p> Methods <p>PubMed, Embase, and Cochrane Library databases were systematically searched up to 30 June, 2025. Recurrent venous thromboembolism, major bleeding, and all-cause mortality were pooled using a random-effects meta-analysis.</p> Results <p>Seven randomized controlled trials and 28 cohort studies were included in our systematic review. After applying the criteria for a 6-month follow-up period, five randomized controlled trials and 16 cohort studies with 49,824 patients were analyzed in the meta-analysis. In randomized controlled trials, DOACs showed a lower incidence of venous thromboembolism recurrence (relative risk [RR] 0.66, 95% confidence interval [CI] 0.49–0.87) compared with LMWH, with a non-significant increase in major bleeding (RR 1.28, 95% CI 0.87–1.88) and no significant difference in all-cause mortality (RR 1.00, 95% CI 0.86–1.18). Cohort studies demonstrated a lower incidence of venous thromboembolism recurrence (RR 0.69, 95% CI 0.62–0.76) with DOACs, a non-significant reduction in major bleeding (RR 0.85, 95% CI 0.68–1.07), and a lower risk of all-cause mortality (RR 0.47, 95% CI 0.31–0.72).</p> Conclusions <p>In patients with cancer-associated thrombosis, DOACs demonstrated a decrease in recurrent venous thromboembolism without increasing the risk of all-cause mortality. A non-significant increase in the risk of major bleeding was recorded in randomized controlled trials, but not in cohort studies. DOACs may provide greater effectiveness for cancer-associated thrombosis compared with LMWH.</p>

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Safety and Effectiveness of Direct Oral Anticoagulants Versus Low-Molecular-Weight Heparin for Cancer-Associated Thrombosis: A Systematic Review and Meta-analysis

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年6月15日

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  • Wei Kang,
  • Bowie P. Y. Lam,
  • Rinko Tsz Lam Lau,
  • Silvia T. H. Li,
  • Kangrui Wu,
  • Yue Wei,
  • Yu Yang,
  • Kyung Jin Lee,
  • Caige Huang,
  • Vincent K. C. Yan,
  • Hei Hang Edmund Yiu,
  • Shing Fung Lee,
  • Aya El Helali,
  • Victor H. F. Lee,
  • Stephen L. Chan,
  • Rina Y. M. Hui,
  • Ka On Lam,
  • Esther W. Chan

摘要

Background

Cancer-associated thrombosis is a condition associated with high mortality rates, yet limited evidence exists regarding the safety and effectiveness of low-molecular-weight heparin (LMWH) and direct oral anticoagulants (DOACs), focusing on a fixed follow-up period based on clinical practice guideline recommendations.

Objective

This study aimed to compare the safety and effectiveness of DOACs versus LMWH in patients with cancer-associated thrombosis over a 6-month follow-up period.

Methods

PubMed, Embase, and Cochrane Library databases were systematically searched up to 30 June, 2025. Recurrent venous thromboembolism, major bleeding, and all-cause mortality were pooled using a random-effects meta-analysis.

Results

Seven randomized controlled trials and 28 cohort studies were included in our systematic review. After applying the criteria for a 6-month follow-up period, five randomized controlled trials and 16 cohort studies with 49,824 patients were analyzed in the meta-analysis. In randomized controlled trials, DOACs showed a lower incidence of venous thromboembolism recurrence (relative risk [RR] 0.66, 95% confidence interval [CI] 0.49–0.87) compared with LMWH, with a non-significant increase in major bleeding (RR 1.28, 95% CI 0.87–1.88) and no significant difference in all-cause mortality (RR 1.00, 95% CI 0.86–1.18). Cohort studies demonstrated a lower incidence of venous thromboembolism recurrence (RR 0.69, 95% CI 0.62–0.76) with DOACs, a non-significant reduction in major bleeding (RR 0.85, 95% CI 0.68–1.07), and a lower risk of all-cause mortality (RR 0.47, 95% CI 0.31–0.72).

Conclusions

In patients with cancer-associated thrombosis, DOACs demonstrated a decrease in recurrent venous thromboembolism without increasing the risk of all-cause mortality. A non-significant increase in the risk of major bleeding was recorded in randomized controlled trials, but not in cohort studies. DOACs may provide greater effectiveness for cancer-associated thrombosis compared with LMWH.