Comparison of direct oral anticoagulants versus low-molecular-weight heparin in primary and metastatic brain cancers: A meta-analysis and systematic review Review
| Authors: | Iyengar, V.; Agrawal, S.; Chiasakul, T.; Tehranchi, K.; McNichol, M.; Carney, B. J.; Leader, A.; Zwicker, J. I.; Patell, R. |
| Review Title: | Comparison of direct oral anticoagulants versus low-molecular-weight heparin in primary and metastatic brain cancers: A meta-analysis and systematic review |
| Abstract: | Background: The safety and efficacy of direct-acting oral anticoagulants (DOACs) for therapeutic anticoagulation in the setting of primary or metastatic brain cancer is not known. Objectives: To conduct a meta-analysis and systematic review of studies that compare the risk of intracranial hemorrhage (ICH) in patients with brain cancer treated with DOACs vs low-molecular-weight heparin (LMWH). Methods: A literature search was conducted using PubMed, EMBASE, and Cochrane databases. Summary statistics were obtained by calculating the risk ratio (RR), and heterogeneity across studies was estimated using the I2 statistic. A total of 10 retrospective studies (n = 1638) met criteria for inclusion. The primary endpoint was the pooled RR for ICH in patients with brain tumors receiving anticoagulation with DOACs compared with those receiving LMWH. Secondary analyses included the risk of fatal ICH in each subgroup. Results: The pooled RR for ICH in patients receiving DOACs vs those receiving LMWH was 0.65 (95% CI, 0.36-1.17; P = .15; I2 = 50%). In studies evaluating primary brain cancer, there was a reduction in risk of ICH with DOACs (RR, 0.35; 95% CI, 0.18-0.69; P = .003; I2 = 0%). In patients with metastatic brain cancer, there was no difference in the risk of ICH with the type of anticoagulation (RR, 1.05; 95% CI, 0.71-1.56; P = .80; I2 = 0%). The overall risk of fatal ICH was not different between anticoagulants. Conclusion: The risk of ICH in patients with brain cancer receiving therapeutic anticoagulation varies by anticoagulation agent and diagnosis of primary or metastatic disease. © 2023 International Society on Thrombosis and Haemostasis |
| Keywords: | primary tumor; retrospective studies; drug tolerability; drug efficacy; drug safety; outcome assessment; brain tumor; brain neoplasms; neoplasm; neoplasms; retrospective study; risk assessment; systematic review; anticoagulants; brain metastasis; brain cancer; anticoagulation; brain hemorrhage; meta analysis; low molecular weight heparin; venous thromboembolism; anticoagulant agent; tumor microenvironment; complication; intracranial hemorrhages; heparin, low-molecular-weight; intracranial hemorrhage; humans; human; article; direct-acting oral anticoagulants |
| Journal Title: | Journal of Thrombosis and Haemostasis |
| Volume: | 22 |
| Issue: | 2 |
| ISSN: | 1538-7933 |
| Publisher: | Wiley Blackwell |
| Date Published: | 2024-02-01 |
| Start Page: | 423 |
| End Page: | 429 |
| Language: | English |
| DOI: | 10.1016/j.jtha.2023.10.011 |
| PUBMED: | 37866517 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PDF -- Source: Scopus |
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