Direct oral anticoagulants versus low-molecular-weight heparin for thromboprophylaxis in cancer-related surgeries: A meta-analysis of efficacy and safety outcomes.

Background: Post-operative venous thromboembolism (VTE) remains a concern following cancer-related surgeries. This systematic review and meta-analysis aimed to evaluate the safety and efficacy of direct oral anticoagulants (DOACs) compared to low molecular weight heparin (LMWH) for thromboprophylaxis after cancer-related surgeries. Methods: We systematically searched databases for studies comparing DOACs to LMWH for post-operative thromboprophylaxis in patients undergoing cancer-related surgeries. Primary outcomes were VTE incidence and bleeding events. Secondary outcomes included all-cause mortality and hospitalization rates. Subgroup analyses examined DOAC type, cancer type, and follow-up duration. A random-effects model calculated pooled risk ratios (RRs) with 95 % confidence intervals (CIs). Results: Analysis included 16 studies with 6400 participants in the DOAC group (mean age 62.05 years, 28.15 % male) and 5801 participants in the LMWH group (mean age 60.78 years, 34.65 % male). DOACs were non-inferior to LMWH for VTE prevention (RR = 0.81, 95 % CI 0.56 to 1.16) with no significant difference in bleeding rates (RR = 0.70, 95 % CI 0.70 to 1.18). Mortality and hospitalization rates were similar between groups. Subgroup analyses suggested possible VTE reduction with DOACs in urological cancer surgeries (RR = 0.52, 95 % CI 0.44 to 0.61) and lower bleeding trends with Apixaban (RR = 0.64, 95 % CI 0.44 to 0.94). Conclusions: DOACs appear non-inferior to LMWH for post-operative thromboprophylaxis in patients undergoing cancer-related surgeries, with comparable safety. The superior VTE prevention in urological cancer surgeries and Apixaban's favorable safety profile warrant further investigation. Moreover, additional research is necessary to clarify the roles of specific DOACs and optimal prophylaxis strategies across various cancer types and surgical procedures.