Comparing survival with vitamin K antagonists, low-molecular-weight heparin, and direct oral anticoagulants in patients with cancer-a systematic review and meta-analysis
Research article published in Research and practice in thrombosis and haemostasis (2025)
Abstract
BACKGROUND: Venous thromboembolism (VTE) is a frequent complication in malignancy. Low-molecular-weight heparins and direct oral anticoagulants have replaced vitamin K antagonists (VKAs) as the standard of care for cancer-associated VTE. Nonetheless, clinical trials have not established a survival benefit of these agents compared with VKA. OBJECTIVES: We conducted a systematic review and meta-analysis to compare survival in cancer patients receiving VKA vs other anticoagulants. METHODS: We searched Embase, Web of Science, PubMed, ClinicalTrials.gov, and Cochrane from inception until April 10, 2025, focusing on the use of VKA and non-VKA in cancer patients. Primary outcome was mortality and secondary outcomes included thromboembolism and bleeding. RESULTS: Of 11,198 studies screened, 14 studies (70,025 patients) were included. VKA were associated with lower mortality than non-VKA in observational studies (odds ratio [OR], 0.84; 95% CI, 0.78-0.91; I 2 = 81%; n = 6 studies) but not in randomized controlled trials (OR, 0.99; 95% CI, 0.86-1.13; I 2 = 0%; n = 8 studies). In subgroup analysis, follow-up period of >6 months (OR, 0.85; 95% CI, 0.79-0.92; I 2 = 75%), solid malignancies (OR, 0.81; 95% CI, 0.75-0.88; I 2 = 78%), and indication of VTE only (OR, 0.89; 95% CI, 0.83-0.96; I 2 = 42%) demonstrated improved survival with VKA. CONCLUSION: The use of VKA was associated with lower mortality than non-VKA anticoagulation in patients with cancer in observational studies but not in randomized trials. The analysis was limited by high heterogeneity, which must be considered when interpreting results.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Venous thromboembolism (VTE) is a frequent complication in malignancy. Low-molecular-weight heparins and direct oral anticoagulants have replaced vitamin K antagonists (VKAs) as the standard of care for cancer-associated VTE.
Por qué esto importa para la hirudoterapia
Esta revisión sistemática y metaanálisis (14 estudios, 70,025 pacientes con cáncer) comparó la supervivencia entre antagonistas de la vitamina K, heparina de bajo peso molecular y anticoagulantes orales directos para la tromboembolia venosa asociada al cáncer, encontrando una menor mortalidad con los antagonistas de la vitamina K en estudios observacionales (OR 0.84) pero sin diferencia de supervivencia en los ensayos aleatorizados (OR 0.99). Para la ASH, documenta cómo se ponderan las diferentes clases de anticoagulantes en una población propensa a la trombosis, el amplio contexto de manejo antitrombótico dentro del cual se posicionan los anticoagulantes naturales del secretoma de la sanguijuela medicinal. Salvedad honesta: los autores señalan una alta heterogeneidad y una clara divergencia entre los hallazgos observacionales y aleatorizados, por lo que el aparente beneficio de los antagonistas de la vitamina K no se confirma mediante RCT; el análisis se refiere a fármacos anticoagulantes sistémicos y no incluye datos sobre, ni mención de, sanguijuelas o hirudoterapia.
Citación
Comparing survival with vitamin K antagonists, low-molecular-weight heparin, and direct oral anticoagulants in patients with cancer-a systematic review and meta-analysis.
Xirou V et al. · Research and practice in thrombosis and haemostasis, 2025
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026