已入深夜,您辛苦了!由于当前在线用户较少,发布求助请尽量完整地填写文献信息,科研通机器人24小时在线,伴您度过漫漫科研夜!祝你早点完成任务,早点休息,好梦!

Direct Oral Anticoagulants vs Low-Molecular-Weight Heparin and Recurrent VTE in Patients With Cancer

医学 低分子肝素 磺达肝素 随机对照试验 内科学 癌症 外科 临床终点 肝素 静脉血栓栓塞 血栓形成
作者
Deborah Schrag,Hajime Uno,Rachel Rosovsky,Cynthia Rutherford,Kristen M. Sanfilippo,John L. Villano,Monic Drescher,Nagesh Jayaram,Chris E. Holmes,Lawrence E. Feldman,Ottavia Zattra,Haley Farrar-Muir,Christine Cronin,Ethan Basch,Anna Weiss,Jean M. Connors,Kenneth Sumida,Robert C. Martin,Maria T. Grosse Perdekamp,Ben Yan
出处
期刊:JAMA [American Medical Association]
卷期号:329 (22): 1924-1924 被引量:94
标识
DOI:10.1001/jama.2023.7843
摘要

In patients with cancer who have venous thromboembolism (VTE) events, long-term anticoagulation with low-molecular-weight heparin (LMWH) is recommended to prevent recurrent VTE. The effectiveness of a direct oral anticoagulant (DOAC) compared with LMWH for preventing recurrent VTE in patients with cancer is uncertain.To evaluate DOACs, compared with LMWH, for preventing recurrent VTE and for rates of bleeding in patients with cancer following an initial VTE event.Unblinded, comparative effectiveness, noninferiority randomized clinical trial conducted at 67 oncology practices in the US that enrolled 671 patients with cancer (any invasive solid tumor, lymphoma, multiple myeloma, or chronic lymphocytic leukemia) who had a new clinical or radiological diagnosis of VTE. Enrollment occurred from December 2016 to April 2020. Final follow-up was in November 2020.Participants were randomized in a 1:1 ratio to either a DOAC (n = 335) or LMWH (n = 336) and were followed up for 6 months or until death. Physicians and patients selected any DOAC or any LMWH (or fondaparinux) and physicians selected drug doses.The primary outcome was the recurrent VTE rate at 6 months. Noninferiority of anticoagulation with a DOAC vs LMWH was defined by the upper limit of the 1-sided 95% CI for the difference of a DOAC relative to LMWH of less than 3% in the randomized cohort that received at least 1 dose of assigned treatment. The 6 prespecified secondary outcomes included major bleeding, which was assessed using a 2.5% noninferiority margin.Between December 2016 and April 2020, 671 participants were randomized and 638 (95%) completed the trial (median age, 64 years; 353 women [55%]). Among those randomized to a DOAC, 330 received at least 1 dose. Among those randomized to LMWH, 308 received at least 1 dose. Rates of recurrent VTE were 6.1% in the DOAC group and 8.8% in the LMWH group (difference, -2.7%; 1-sided 95% CI, -100% to 0.7%) consistent with the prespecified noninferiority criterion. Of 6 prespecified secondary outcomes, none were statistically significant. Major bleeding occurred in 5.2% of participants in the DOAC group and 5.6% in the LMWH group (difference, -0.4%; 1-sided 95% CI, -100% to 2.5%) and did not meet the noninferiority criterion. Severe adverse events occurred in 33.8% of participants in the DOAC group and 35.1% in the LMWH group. The most common serious adverse events were anemia and death.Among adults with cancer and VTE, DOACs were noninferior to LMWH for preventing recurrent VTE over 6-month follow-up. These findings support use of a DOAC to prevent recurrent VTE in patients with cancer.ClinicalTrials.gov Identifier: NCT02744092.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
L.C.完成签到,获得积分10
刚刚
刚刚
1秒前
千纸鹤完成签到 ,获得积分10
3秒前
4秒前
6秒前
充电宝应助甜蜜邑采纳,获得10
7秒前
100完成签到,获得积分10
10秒前
11秒前
HB完成签到,获得积分10
13秒前
怕黑的路人完成签到,获得积分10
15秒前
HH完成签到,获得积分10
16秒前
CipherSage应助蟹治猿采纳,获得10
18秒前
川荣李奈完成签到 ,获得积分10
19秒前
雪生在无人荒野完成签到,获得积分10
20秒前
动听的谷秋完成签到 ,获得积分10
20秒前
寒冷的青筠完成签到 ,获得积分10
21秒前
陈博士关注了科研通微信公众号
21秒前
朴实剑通完成签到,获得积分10
23秒前
火星上的柏柳完成签到 ,获得积分10
24秒前
luocan完成签到,获得积分10
25秒前
想法文章的菜鸟完成签到,获得积分10
26秒前
27秒前
星辰大海应助科研通管家采纳,获得10
28秒前
桐桐应助科研通管家采纳,获得10
28秒前
JamesPei应助科研通管家采纳,获得10
28秒前
风清扬完成签到,获得积分10
28秒前
28秒前
科研通AI2S应助科研通管家采纳,获得10
28秒前
小马甲应助科研通管家采纳,获得10
28秒前
28秒前
储物间完成签到,获得积分10
28秒前
非了个凡完成签到 ,获得积分10
31秒前
32秒前
秀丽奎完成签到 ,获得积分10
34秒前
充电宝应助HH采纳,获得10
36秒前
KONOHA完成签到,获得积分10
37秒前
橙子完成签到,获得积分10
37秒前
花深粥发布了新的文献求助10
37秒前
每文完成签到,获得积分10
38秒前
高分求助中
(应助此贴封号)【重要!!请各用户(尤其是新用户)详细阅读】【科研通的精品贴汇总】 10000
Comprehensive Methanol Science Production, Applications, and Emerging Technologies 1200
Architectural Corrosion and Critical Infrastructure 1000
Early Devonian echinoderms from Victoria (Rhombifera, Blastoidea and Ophiocistioidea) 1000
By R. Scott Kretchmar - Practical Philosophy of Sport and Physical Activity - 2nd (second) Edition: 2nd (second) Edition 666
Electrochemistry: Volume 17 600
Physical Chemistry: How Chemistry Works 500
热门求助领域 (近24小时)
化学 医学 生物 材料科学 工程类 有机化学 内科学 生物化学 物理 计算机科学 纳米技术 遗传学 基因 复合材料 化学工程 物理化学 病理 催化作用 免疫学 量子力学
热门帖子
关注 科研通微信公众号,转发送积分 4944455
求助须知:如何正确求助?哪些是违规求助? 4209377
关于积分的说明 13085135
捐赠科研通 3989004
什么是DOI,文献DOI怎么找? 2183965
邀请新用户注册赠送积分活动 1199322
关于科研通互助平台的介绍 1112234