当前位置: X-MOL 学术J. Thromb. Thrombolysis › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
The incidence of major bleeding in adult patients with urogenital and gynecological cancer being treated with direct oral anticoagulants (DOACs): a systematic review
Journal of Thrombosis and Thrombolysis ( IF 4 ) Pub Date : 2024-03-01 , DOI: 10.1007/s11239-024-02956-5
L. Al-Tourah , S. Mithoowani , W Lim , Rick Ikesaka

Background

Direct oral anticoagulants (DOACs) are the mainstay of treatment for venous thromboembolism (VTE) and non-valvular atrial fibrillation (AF), with or without an underlying cancer. Patients with cancer have a 2-3-fold increase in risk for bleeding complications compared to non-cancer patients taking anticoagulant therapy, however the incidence of bleeding for urogenital and gynecological cancers on DOACs are uncertain.

Aims

To assess the bleeding risk associated with the use of DOACs in patients with urogenital and/or gynecological cancers.

Method

We conducted a systematic review of randomized controlled trials (RCTs) and prospective cohort studies to address the safety of DOACs for VTE and AF when used in patients with urogenital and/or gynecological malignancy. The primary outcomes assessed were major and clinically relevant non-major (CRNMB) bleeding, with minor bleeding considered as a secondary outcome. MEDLINE, EMBASE and COCHRANE Central Registry of Controlled Trials were searched up to and including Oct 28, 2022. The study protocol was registered in PROSPERO (CRD42022370981). Studies were independently assessed for inclusion and data extracted in duplicate.

Result

Seven studies met our inclusion criteria (Fig. 1): 2 RCTs and 5 prospective cohort studies. A total of 676 patients treated with DOACs were included, 628 (92.8%) had VTE and 48 (7.1%) had AF. In patients with VTE treated with DOACs, the pooled major bleeding rate was 2.1%, 95% confidence intervals (CI) 0.9–3.3% (Fig. 2). Pooled estimates could not be determined for AF patients given small event and patient numbers.

Conclusion

Major bleeding rates in urogenital and/or gynecological cancer patients treated with DOACs are similar to that of the general cancer population.



中文翻译:

接受直接口服抗凝剂(DOAC)治疗的成年泌尿生殖道和妇科癌症患者大出血的发生率:系统评价

背景

直接口服抗凝剂(DOAC)是治疗静脉血栓栓塞(VTE)和非瓣膜性心房颤动(AF)(无论是否患有潜在癌症)的主要方法。与接受抗凝治疗的非癌症患者相比,癌症患者发生出血并发症的风险增加 2-3 倍,但 DOAC 治疗泌尿生殖系统和妇科癌症的出血发生率尚不确定。

目标

评估泌尿生殖系统和/或妇科癌症患者使用 DOAC 相关的出血风险。

方法

我们对随机对照试验 (RCT) 和前瞻性队列研究进行了系统评价,以探讨 DOAC 用于泌尿生殖系统和/或妇科恶性肿瘤患者治疗 VTE 和 AF 的安全性。评估的主要结局是大出血和临床相关的非大出血(CRNMB),轻微出血被视为次要结局。MEDLINE、EMBASE 和 COCHRANE 对照试验中央登记处的检索截止日期为 2022 年 10 月 28 日(含)。该研究方案已在 PROSPERO 中注册(CRD42022370981)。对研究的纳入进行独立评估,并一式两份提取数据。

结果

七项研究符合我们的纳入标准(图 1):2 项随机对照试验和 5 项前瞻性队列研究。总共纳入了 676 名接受 DOAC 治疗的患者,其中 628 名(92.8%)患有 VTE,48 名(7.1%)患有 AF。在接受 DOAC 治疗的 VTE 患者中,汇总大出血率为 2.1%,95% 置信区间 (CI) 0.9-3.3%(图 2)。鉴于事件和患者数量较小,无法确定 AF 患者的汇总估计值。

结论

使用 DOAC 治疗的泌尿生殖系统和/或妇科癌症患者的大出血率与一般癌症人群相似。

更新日期:2024-03-03
down
wechat
bug