The effect of anticoagulants on preventing venous thromboembolism in cancer patients: A systematic review and meta-analysis

Background We aimed to evaluate the efficacy and safety of anticoagulant therapy, especially direct oral anticoagulant (DOAC) therapy, for primary prevention of venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism (PE), in non-bedridden cancer patients undergoing chemotherapy. Methods English and Chinese literature published from the inception of the databases up to December 2022 was extracted from five databases: PubMed, Embase, MEDLINE, Wanfang Medical and CNKI. Statistical analysis was done using Stata/SE 16.0 software. Results Eight randomized controlled trials were included in this meta-analysis. The results showed that DOACs were effective in preventing symptomatic PE in cancer patients (Log risk ratio [RR]=-0.89, 95% confidence interval [CI]: -1.73, -0.05). Moreover, compared to the control group, DOACs did not increase the risk of major bleeding (Log RR 0.55, 95% CI -0.20, 1.30). Conclusion The meta-analysis indicates that in cancer patients, DOACs have a significant effect on the prevention of PE, with good safety profile and no increased risk of major bleeding.