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Direct oral anticoagulants (DOACs) versus low-molecular-weight heparin (LMWH) for extended thromboprophylaxis following major abdominal/pelvic cancer-related surgery: a systematic review and meta-analysis.
Zhou, Hong; Ye, Ling-Ling; Zhou, Jin-Tuo; Ma, Fu-Xin; Ma, Jun-Jie; Zhang, Jin-Hua.
Afiliación
  • Zhou H; Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, Fujian, China.
  • Ye LL; Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, Fujian, China.
  • Zhou JT; Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, Fujian, China.
  • Ma FX; Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, Fujian, China.
  • Ma JJ; School of Medicine, Huaqiao University, Quanzhou, 362021, Fujian, China. majunjie3612@hqu.edu.cn.
  • Zhang JH; Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, Fujian, China. pollyzhang2006@126.com.
Surg Endosc ; 38(3): 1131-1138, 2024 Mar.
Article en En | MEDLINE | ID: mdl-38267639
ABSTRACT

BACKGROUND:

The use of direct oral anticoagulants (DOACs) as an alternative to low-molecular-weight heparin (LMWH) for extended thromboprophylaxis of abdominal/pelvic cancer-related postoperative thromboembolism (VTE) is unclear. We aim to investigate the efficacy and safety of DOACs vs. LMWH in these patients.

METHODS:

A systematic review was conducted using EMBASE, MEDLINE, CENTRAL, and Web of science through May 19th, 2023 for all randomized controlled trials (RCTs) and observational studies that compared the outcomes with DOACs vs. LMWH for extended thromboprophylaxis among patients undergoing abdominal/pelvic cancer surgery. Primary efficacy outcome was clinical VTE, and safety outcome was clinically relevant bleeding complications reported within the 30-day postoperative period. This study was registered in PROSPERO (CRD42023413175).

RESULTS:

We identified 5078 articles and selected 29 full-text articles for eligibility. A total of 9 studies (2 RCTs and 7 observational studies) encompassing 2651 patients were included for systematic review and 7 for meta-analysis. When compared with LMWH extended thromboprophylaxis, DOACs had a similar incidence of VTE (RR 0.65 [95% CI 0.32-1.33], I2 = 0%), major bleeding (RR 1.68 [95% CI 0.36-7.9], I2 = 26%), and clinically relevant non-major bleeding (RR 0.68 [95% CI 0.39-1.19], I2 = 0%). Subgroup analysis suggested no difference according to the study type (RCTs versus observational studies) regarding clinical VTE or major bleeding (Pinteraction = 0.43 and Pinteraction = 0.71, respectively).

CONCLUSION:

Our results suggest that DOACs for extended thromboprophylaxis were an effective and safe alternative to LMWH after major abdominal/pelvic cancer-related surgery.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Pélvicas / Complicaciones Posoperatorias / Heparina de Bajo-Peso-Molecular / Tromboembolia Venosa / Anticoagulantes Tipo de estudio: Clinical_trials / Observational_studies / Systematic_reviews Límite: Humans Idioma: En Revista: Surg Endosc Asunto de la revista: DIAGNOSTICO POR IMAGEM / GASTROENTEROLOGIA Año: 2024 Tipo del documento: Article País de afiliación: China Pais de publicación: Alemania

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Pélvicas / Complicaciones Posoperatorias / Heparina de Bajo-Peso-Molecular / Tromboembolia Venosa / Anticoagulantes Tipo de estudio: Clinical_trials / Observational_studies / Systematic_reviews Límite: Humans Idioma: En Revista: Surg Endosc Asunto de la revista: DIAGNOSTICO POR IMAGEM / GASTROENTEROLOGIA Año: 2024 Tipo del documento: Article País de afiliación: China Pais de publicación: Alemania