ISSN: 2960-1959
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Review Articles

Edoxaban and Cancer-Associated Venous Thromboembolism: A Meta-analysis of Clinical Trials

Fahmi H. Kakamad
College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq
Sami S. Omar
Rizgary Oncology Center, Erbil, Iraq
Farman J. Ahmed
Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
Dana H. Mohammed Saeed
Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
Rebaz M. Ali
Hiwa Cancer Hospital, Sulaimani Directorate of Health, Sulaymaniyah, Iraq
Marwan N. Hassan
Kscien Organization for Scientific Research (Middle East Office), Hamdi Street, Azadi Mall, Sulaymaniyah, Iraq
Karokh F. Hamahussein
Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
Nsren S. Sabr
Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
Hawkar A. Nasralla
Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
Mohammed Q. Mustafa
Department of Medical Analysis, Tishk International University, Erbil, Iraq
Diyar A. Omar
Medical Laboratory Technology, Shaqlawa Technical College, Erbil Polytechnic University, Erbil, Iraq
Soran H. Tahir
Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
Rezheen J. Rashid
Hiwa Cancer Hospital, Sulaimani Directorate of Health, Sulaymaniyah, Iraq
Tara N. Mohammed
Xzmat polyclinic, Rizgari, Kalar, Sulaymaniyah, Iraq
Shvan H. Mohammed
Xzmat polyclinic, Rizgari, Kalar, Sulaymaniyah, Iraq
Abstract
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Submitted: October 25, 2024
Published: December 2, 2024
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Abstract

Introduction

Cancer patients face a venous thromboembolism (VTE) risk that is up to 50 times higher compared to individuals without cancer. In 2010, direct oral anticoagulants (DOACs) such as apixaban, rivaroxaban, and edoxaban were introduced, consequently becoming the controversial oral anticoagulants for VTE therapy. This study is a meta-analysis of randomized clinical trials (RCTs) evaluating the use of edoxaban for treating VTE in cancer patients over different treatment durations.

Methods

Using Google Scholar, a systematic search for RCTs on edoxaban for cancer-associated VTE was performed. The data extracted covered patient numbers, age, gender, BMI, cancer type, edoxaban dosage, treatment duration, comorbidities, major bleeding, recurrent VTE incidence, and deaths. Statistical significance was set at 0.05.

Results

Out of 52 studies, nine with 3,190 cases met the inclusion criteria. The mean age was 66.68 years, with 1,604 females (50.28%). Major bleeding occurred in 192 patients (7.66%) in the 6- or 12-month group and 57 (8.35%) in the 3-month group (p=0.573). Recurrent VTE was observed in 145 patients (5.78%) in the 6- or 12-month group and 95 (13.91%) in the 3-month group (p<0.001). Deaths from any cause totaled 548 (21.86%) in the 6- or 12-month group and 165 (24.16%) in the 3-month group (p=0.110).

Conclusion

Cancer patients receiving edoxaban for six or 12 months experience a lower recurrence rate of VTE compared to those on a 3-month treatment. The incidence of major bleeding appears to be similar between the two treatment durations.

References

  1. Van Es N, Di Nisio M, Bleker SM, Segers A, Mercuri MF, Schwocho et al. Edoxaban for treatment of venous thromboembolism in patients with cancer. Thrombosis and haemostasis. 2015;114(12):1268-76. doi:10.1160/TH15-06-0452 DOI: https://doi.org/10.1160/TH15-06-0452
  2. Mingomataj E, Krasniqi M, Dedushi K, Sergeevich KA, Kust D, Qadir AA. Cancer Publications in One Year (2023): A Cross-Sectional Study. Barw Medical Journal. 2024;2(1):3-11. doi:10.58742/g9q9t715 DOI: https://doi.org/10.58742/g9q9t715
  3. Mulder FI, van Es N, Kraaijpoel N, Di Nisio M, Carrier M, Duggal A et al. Edoxaban for treatment of venous thromboembolism in patient groups with different types of cancer: Results from the Hokusai VTE Cancer study (vol 185, pg 13, 2020). Thrombosis Research. 2020;191:156-9. doi:10.1016/j.thromres.2019.11.007 DOI: https://doi.org/10.1016/j.thromres.2020.02.022
  4. Oride T, Sawada K, Shimizu A, Kinose Y, Takiuchi T, Kodama M et al. Clinical trial assessing the safety of edoxaban with concomitant chemotherapy in patients with gynecological cancer-associated thrombosis (EGCAT study). Thrombosis Journal. 2023;21(1):57. doi:10.1186/s12959-023-00500-8 DOI: https://doi.org/10.1186/s12959-023-00500-8
  5. Di Nisio M, van Es N, Carrier M, Wang TF, Garcia D, Segers A et al. Extended treatment with edoxaban in cancer patients with venous thromboembolism: A post‐hoc analysis of the Hokusai‐VTE Cancer study. Journal of Thrombosis and Haemostasis. 2019;17(11):1866-74. doi:10.1111/jth.14561 DOI: https://doi.org/10.1111/jth.14561
  6. Agnelli G, Buller HR, Cohen A, Curto M, Gallus AS, Johnson M et al. Oral apixaban for the treatment of acute venous thromboembolism. New England Journal of Medicine. 2013;369(9):799-808. doi:10.1056/NEJMoa1302507 DOI: https://doi.org/10.1056/NEJMoa1302507
  7. Einstein Investigators. Oral rivaroxaban for symptomatic venous thromboembolism. New England Journal of Medicine. 2010;363(26):2499-510. doi:10.1056/NEJMoa1007903 DOI: https://doi.org/10.1056/NEJMoa1007903
  8. Raskob GE, Van Es N, Verhamme P, Carrier M, Di Nisio M, Garcia D et al. Edoxaban for the treatment of cancer-associated venous thromboembolism. New England Journal of Medicine. 2018;378(7):615-24. doi:10.1056/NEJMoa1711948 DOI: https://doi.org/10.1056/NEJMoa1711948
  9. Young AM, Marshall A, Thirlwall J, Chapman O, Lokare A, Hill C, Hale D, Dunn JA, Lyman GH, Hutchinson C, MacCallum P. Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D). Journal of Clinical Oncology. 2018 Jul 10;36(20):2017-23. doi:10.1200/JCO.2018.78.8034 DOI: https://doi.org/10.1200/JCO.2018.78.8034
  10. Abdullah HO, Abdalla BA, Kakamad FH, Ahmed JO, Baba HO, Hassan MN, et al. Predatory Publishing Lists: A Review on the Ongoing Battle Against Fraudulent Actions. Barw Medical Journal. 2024;2(2):26-30. doi:10.58742/bmj.v2i2.91 DOI: https://doi.org/10.58742/bmj.v2i2.91
  11. Chatani R, Yamashita Y, Morimoto T, Muraoka N, Umetsu M, Nishimoto Y et al. Edoxaban for 12 Versus 3 Months in Cancer-associated Isolated Distal Deep Vein Thrombosis According to Different Doses: Insights from the ONCO DVT study. European Heart Journal-Cardiovascular Pharmacotherapy. 2024:pvae028. doi:10.1093/ehjcvp/pvae028 DOI: https://doi.org/10.1093/ehjcvp/pvae028
  12. Chung JW, Hwang J, Kim HJ, Seo WK, Ahn MJ, Saver JL, Bang OY. Edoxaban for the treatment of hypercoagulability and cerebral thromboembolism associated with cancer: a randomized clinical trial of biomarker targets. International Journal of Stroke. 2024: 19(6) 645–653. doi:10.1177/17474930241239266 DOI: https://doi.org/10.1177/17474930241239266
  13. Nakamura M, Ishiguro A, Dazai M, Kawamoto Y, Yuki S, Sogabe S, et al. Feasibility of edoxaban for asymptomatic cancer-associated thrombosis in Japanese patients with gastrointestinal cancer: ExCAVE study. BMC cancer. 2022;22(1):13-22. doi:10.1186/s12885-022-10403-y DOI: https://doi.org/10.1186/s12885-022-10403-y
  14. Raskob GE, van Es N, Segers A, Angchaisuksiri P, Oh D, Boda Z et al. Edoxaban for venous thromboembolism in patients with cancer: results from a non-inferiority subgroup analysis of the Hokusai-VTE randomised, double-blind, double-dummy trial. The Lancet Haematology. 2016;3(8):e379-87. doi:10.1016/S2352-3026(16)30057-6 DOI: https://doi.org/10.1016/S2352-3026(16)30057-6
  15. Yamashita Y, Morimoto T, Muraoka N, Oyakawa T, Umetsu M, Akamatsu D et al. Edoxaban for 12 months versus 3 months in patients with cancer with isolated distal deep vein thrombosis (ONCO DVT study): an open-label, multicenter, randomized clinical trial. Circulation. 2023;148(21):1665-76. doi:10.1161/CIRCULATIONAHA.123.066360 DOI: https://doi.org/10.1161/CIRCULATIONAHA.123.066360
  16. Hara N, Miyamoto T, Iwai T, Yamaguchi J, Hijikata S, Watanabe K et al. Assessment of the safety and efficacy of edoxaban for treating venous thromboembolism secondary to active malignancy. Annals of Vascular Diseases. 2017;10(4):407-10. doi:10.3400/avd.oa.17-00054 DOI: https://doi.org/10.3400/avd.oa.17-00054
  17. Ikeda S, Koga S, Yamagata Y, Eguchi M, Sato D, Muroya T et al. Comparison of the effects of edoxaban, an oral direct factor Xa inhibitor, on venous thromboembolism between patients with and without cancer. Journal of cardiology. 2018;72(2):120-7. doi:10.1016/j.jjcc.2018.03.006 DOI: https://doi.org/10.1016/j.jjcc.2018.03.006
  18. Cohen AL, Lim CS, Davies AH. Is there a role yet for new direct oral anticoagulants in cancer patients?. Phlebology. 2016(3):157-9. doi:10.1177/0268355515604255 DOI: https://doi.org/10.1177/0268355515604255
  19. Rak J, Yu JL, Luyendyk J, Mackman N. Oncogenes, trousseau syndrome, and cancer-related changes in the coagulome of mice and humans. Cancer research. 2006;66(22):10643-6. doi:10.1158/0008-5472.CAN-06-2350 DOI: https://doi.org/10.1158/0008-5472.CAN-06-2350
  20. Deitcher SR, Kessler CM, Merli G, Rigas JR, Lyons RM, Fareed J. Secondary prevention of venous thromboembolic events in patients with active cancer: enoxaparin alone versus initial enoxaparin followed by warfarin for a 180-day period. Clinical and applied thrombosis/hemostasis. 2006;12(4):389-96. doi:10.1177/1076029606293692 DOI: https://doi.org/10.1177/1076029606293692
  21. Hull RD, Pineo GF, Brant RF, Mah AF, Burke N, Dear R et al. Long-term low-molecular-weight heparin versus usual care in proximal-vein thrombosis patients with cancer. The American journal of medicine. 2006;119(12):1062-72. doi:10.1016/j.amjmed.2006.02.022 DOI: https://doi.org/10.1016/j.amjmed.2006.02.022
  22. Lee AY, Levine MN, Baker RI, Bowden C, Kakkar AK, Prins M et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. New England journal of medicine. 2003;349(2):146-53. doi:10.1056/NEJMoa025313 DOI: https://doi.org/10.1056/NEJMoa025313
  23. Lee AY, Kamphuisen PW, Meyer G, Bauersachs R, Janas MS, Jarner MF et al. Tinzaparin vs warfarin for treatment of acute venous thromboembolism in patients with active cancer: a randomized clinical trial. Jama. 2015;314(7):677-86. doi:10.1001/jama.2015.9243 DOI: https://doi.org/10.1001/jama.2015.9243
  24. Prins MH, Lensing AW, Brighton TA, Lyons RM, Rehm J, Trajanovic M et al. Oral rivaroxaban versus enoxaparin with vitamin K antagonist for the treatment of symptomatic venous thromboembolism in patients with cancer (EINSTEIN-DVT and EINSTEIN-PE): a pooled subgroup analysis of two randomised controlled trials. The Lancet Haematology. 2014 Oct 1;1(1):e37-46. doi:10.1016/S2352-3026(14)70018-3 DOI: https://doi.org/10.1016/S2352-3026(14)70018-3

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