Rivaroxaban versus enoxaparin for the prevention of recurrent venous thromboembolism in patients with cancer A meta-analysis

Background: Although low-molecular-weight heparin (LMWH) is recommended as the first-line treatment in patients with active cancer and venous thromboembolism (VTE), many patients are more willing to choose oral anticoagulants. We collected currently available data to evaluate the efficacy and safety of the oral direct factor Xa inhibitor rivaroxaban compared with enoxaparin in patients with cancer and VTE. Methods: We retrieved electric databases, including Medline/PubMed and EMBASE, from inception through January, 2018. We included articles comparing enoxaparin with rivaroxaban in patients with cancer and VTE. Recurrences of VTE, incidence of major bleeding and deaths were compared between groups. Poole analysis was conducted in Review Manager Version 5.2. Results: A total of 4 articles and 667 patients were included in the final analysis. Pooled analysis showed that rivaroxaban was associated with a non-significantly lower recurrence of VTE (risk ratio [RR] = 0.55, 95% confidence interval (95%CI): 0.28-1.06, I-2 = 0%). Patients treated with rivaroxaban had a similar major bleeding risk compared with those administrated with enoxaparin (RR = 0.84, 95%CI: 0.39-1.83, I-2 = 0%). No significant difference was observed in mortality between the 2 groups (RR = 0.51, 95%CI: 0.15-1.80, I-2 = 89%). Conclusion: Rivaroxaban is as effective and safe as enoxaparin for the prevention of recurrent VTE in patients with malignancy. Rivaroxaban is a potential option for patients with cancer and VTE.