Anticoagulation for the Prevention of Arterial Thrombosis in Ambulatory Cancer Patients: Systematic Review and Meta-Analysis
Abstract:
Background: The risk of arterial thrombotic events (ATE) is high among patients on systemic anti-cancer therapies. Despite the efficacy of anticoagulants in the prevention of cancer-associated venous thromboembolism, it is unknown whether anticoagulation is effective to prevent ATEs.
Objectives: To examine the efficacy and safety of anticoagulants in ATE prevention among ambulatory cancer patients.
Methods: We performed a systematic review using Medline, Embase, Scopus and CENTRAL from inception to May 21, 2022, and included studies comparing oral or parenteral anticoagulation to no anticoagulation among ambulatory patients receiving systemic anti-cancer therapy with no other indication for anticoagulation. The primary outcome was ATE (myocardial infarction, ischemic stroke, intra-abdominal arterial embolism, or peripheral artery occlusion). Secondary outcomes were major and non-major bleeding, and all-cause mortality.
Results: Fourteen randomized trials involving low-molecular-weight heparins, direct oral anticoagulants, and warfarin were included. ATEs were captured as co-efficacy endpoints or adverse events. Anticoagulant use was not associated with a reduction in ATE compared with placebo or standard treatment (relative risk [RR] 0.73, 95% CI 0.50-1.04, p=0.08, I2=0%). Relative risks of major and minor bleeding were 1.56 (95% CI 1.12-2.17) and 2.25 (95% CI 1.45-3.48) with anticoagulant use. In 13 trials that reported all-cause mortality, risk of death was not reduced with anticoagulants (RR 0.99; 95% CI, 0.95-1.02; p=0.84; I2 = 0%).
Conclusions: Anticoagulants did not reduce ATE risks among ambulatory patients on systemic anti-cancer therapy and was associated with increased bleeding. Based on current data, anticoagulants have limited roles in ATE prevention in this population as a whole.
JACC CardioOncology Editor-in-Chief and CME Editor
Bonnie Ky, MD, MSCE, FACC
Author
Ahmad M. Sllim, MD, FACC, FASNC, FSCCT
Important Dates
Date of Release: August 15, 2023
Term of Approval/Date of CME/MOC Expiration: August 14, 2024