Abstract：
BACKGROUND: Direct oral anticoagulants (DOACs) used as an alternative to low-molecular-weight heparin (LMWH) for thromboprophylaxis after cancer surgery for venous thromboembolic events (VTE) remains unclear. This study aimed to investigate the efficacy and safety of DOACs versus LMWH in these patients.
METHODS: A search of EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science was carried out and included all randomized controlled trials (RCTs) and observational studies that directly compared DOACs with LMWH for thromboprophylaxis in patients after cancer surgery through July 25, 2023. The primary efficacy and safety outcomes were VTE, major bleeding, and clinically relevant non-major bleeding (CRNMB) within 30 days of surgery. The risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB2) tool for RCTs and ROBINS-I tool for non-randomized studies. This study was registered in PROSPERO (CRD42023445386).
RESULTS: We retrieved 5149articles, selected 27 for eligibility, and included 10 studies (three RCTs and seven observational studies) encompassing 3054 patients who underwent postoperative thromboprophylaxis with DOACs (41%) or LMWH (59%). Compared to LMWH thromboprophylaxis, DOACs had a comparable risk of VTE (RR:0.69[95% CI:0.46-1.02], I2 = 0%), major bleeding (RR:1.55 [95% CI:0.82-2.93], I2 = 2%), and CRNMB (RR, 0.89 [95% CI, 0.4-1.98], I2 = 31%) during the 30-day postoperative period. Subgroup analysis of VTE and major bleeding suggested no differences according to study type, extended thromboprophylaxis, tumor types, or different types of DOAC.
CONCLUSIONS: DOACs are potentially effective alternatives to LMWH for thromboprophylaxis in patients undergoing cancer surgery, without increasing the risk of major bleeding events.
METHODS: A search of EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science was carried out and included all randomized controlled trials (RCTs) and observational studies that directly compared DOACs with LMWH for thromboprophylaxis in patients after cancer surgery through July 25, 2023. The primary efficacy and safety outcomes were VTE, major bleeding, and clinically relevant non-major bleeding (CRNMB) within 30 days of surgery. The risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB2) tool for RCTs and ROBINS-I tool for non-randomized studies. This study was registered in PROSPERO (CRD42023445386).
RESULTS: We retrieved 5149articles, selected 27 for eligibility, and included 10 studies (three RCTs and seven observational studies) encompassing 3054 patients who underwent postoperative thromboprophylaxis with DOACs (41%) or LMWH (59%). Compared to LMWH thromboprophylaxis, DOACs had a comparable risk of VTE (RR:0.69[95% CI:0.46-1.02], I2 = 0%), major bleeding (RR:1.55 [95% CI:0.82-2.93], I2 = 2%), and CRNMB (RR, 0.89 [95% CI, 0.4-1.98], I2 = 31%) during the 30-day postoperative period. Subgroup analysis of VTE and major bleeding suggested no differences according to study type, extended thromboprophylaxis, tumor types, or different types of DOAC.
CONCLUSIONS: DOACs are potentially effective alternatives to LMWH for thromboprophylaxis in patients undergoing cancer surgery, without increasing the risk of major bleeding events.
摘要：
背景：直接口服抗凝剂（DOAC）替代低分子量肝素（LMWH）用于癌症手术后静脉血栓栓塞事件（VTE）的血栓预防尚不清楚。本研究旨在探讨DOAC与LMWH在这些患者中的疗效和安全性。
方法：搜索EMBASE，MEDLINE,Cochrane中央对照试验登记册（中央），和WebofScience进行了研究,纳入了所有随机对照试验(RCT)和观察性研究,这些研究直接比较了DOAC和LMWH在截至2023年7月25日癌症手术后患者血栓预防中的作用.主要疗效和安全性结果是VTE，大出血,以及手术后30天内临床相关的非大出血（CRNMB）。使用Cochrane偏差风险2（RoB2）工具进行RCT和ROBINS-I工具进行非随机研究，评估偏差风险。本研究在PROSPERO（CRD42023445386）注册。
结果：我们检索到5149篇文章，入选27名资格，纳入10项研究(3项RCT和7项观察性研究),纳入3054例接受DOAC(41%)或LMWH(59%)术后血栓预防的患者.与LMWH血栓预防相比，DOAC具有相当的VTE风险(RR：0.69[95%CI：0.46-1.02]，I2=0%)，大出血（RR：1.55[95%CI：0.82-2.93]，I2=2%)，和CRNMB(RR，0.89[95%CI，0.4-1.98]，I2=31％）在术后30天期间。静脉血栓栓塞和大出血的亚组分析提示根据研究类型没有差异，延长血栓预防，肿瘤类型,或不同类型的DOAC。
结论：DOAC是LMWH的潜在有效替代方案，用于癌症手术患者的血栓预防。不会增加大出血事件的风险。
方法：搜索EMBASE，MEDLINE,Cochrane中央对照试验登记册（中央），和WebofScience进行了研究,纳入了所有随机对照试验(RCT)和观察性研究,这些研究直接比较了DOAC和LMWH在截至2023年7月25日癌症手术后患者血栓预防中的作用.主要疗效和安全性结果是VTE，大出血,以及手术后30天内临床相关的非大出血（CRNMB）。使用Cochrane偏差风险2（RoB2）工具进行RCT和ROBINS-I工具进行非随机研究，评估偏差风险。本研究在PROSPERO（CRD42023445386）注册。
结果：我们检索到5149篇文章，入选27名资格，纳入10项研究(3项RCT和7项观察性研究),纳入3054例接受DOAC(41%)或LMWH(59%)术后血栓预防的患者.与LMWH血栓预防相比，DOAC具有相当的VTE风险(RR：0.69[95%CI：0.46-1.02]，I2=0%)，大出血（RR：1.55[95%CI：0.82-2.93]，I2=2%)，和CRNMB(RR，0.89[95%CI，0.4-1.98]，I2=31％）在术后30天期间。静脉血栓栓塞和大出血的亚组分析提示根据研究类型没有差异，延长血栓预防，肿瘤类型,或不同类型的DOAC。
结论：DOAC是LMWH的潜在有效替代方案，用于癌症手术患者的血栓预防。不会增加大出血事件的风险。
