The efficacy and safety of DOACs versus LMWH for cancer-associated thrombosis: A systematic review and meta-analysis

Venous thromboembolism (VTE) remains the second most common cause of death in cancer patients. Direct oral anticoagulants (DOACs) have revolutionized treatment of VTE, though cancer patients were underrepresented in early trials. Low-molecular weight heparins (LMWH) have been the gold-standard for treatment of cancer-associated thrombosis (CAT) until publication of several randomized controlled trials (RCT) exploring DOACs for CAT. In 2019, two systematic reviews and meta-analyses evaluated two RCTs and showed a trend toward reduced VTE recurrence and increased major bleeding with DOACs compared with LMWH. We performed an updated systematic review and meta-analysis on the efficacy and safety of DOACs for CAT.