Comparison of efficacy and safety of thrombus prevention strategies after abdominal and pelvic cancer surgery: Bayesian network based meta-analysis

TL;DR

This study compares different strategies to prevent blood clots after abdominal and pelvic cancer surgery, finding that direct oral anticoagulants are most effective and safe.

Contribution

The study introduces a Bayesian network meta-analysis to compare thromboprophylaxis strategies, identifying DOACs as the optimal choice.

Findings

DOACs showed the highest efficacy in preventing venous thromboembolism compared to no treatment.

LMWH was more effective than no treatment and had similar safety to physiotherapy.

UFH had a higher risk of major bleeding compared to LMWH and physiotherapy.

Abstract

The occurrence of venous thromboembolism (VTE) after abdominal and pelvic cancer surgery increases the risk of mortality and disability. However, there is insufficient evidence supporting the choice of anticoagulation strategies.

We searched PubMed, The Cochrane Library, Embase, and Web of Science for randomized controlled trials from inception to January 2024. Studies concerning thrombosis prevention after abdominal and pelvic surgery were included. Network meta-analysis(NMA) and direct meta-analysis (DMA) methods were employed to evaluate the efficacy and safety of various prophylactic strategies.

Twenty clinical trials involving a total of 4923 patients were included. The DMA results showed that low molecular weight heparin (LMWH) was more effective in preventing VTE compared to no treatment (OR = 1.96; 95% CI: 1.21 to 3.19), and LMWH plus physiotherapy was more effective than LMWH (OR = 10.95; 95% CI: 1.33 to 90.40). The NMA results indicated that DOACs (OR = 0.34; 95% CI: 0.11 to 0.76) and LMWH (OR = 0.51; 95% CI: 0.32 to 0.77) were significantly effective in preventing venous thrombosis compared with no treatment. The cumulative ranking probability curve (SUCRA) showed that direct oral anticoagulants (DOACs) were the best intervention. In terms of major bleeding, unfractionated heparin (UFH) had a higher risk than LMWH, physiotherapy, and no treatment, with statistically significant differences. The SUCRA analysis indicated that physiotherapy was the best intervention for major bleeding.

Existing evidence suggests that DOACs can provide better thromboprophylaxis efficacy for patients after abdominal and pelvic cancer surgery, achieving an optimal balance between efficacy and safety. LMWH has become an intervention with efficacy second only to DOACs, with similar safety.

https://www.crd.york.ac.uk/prospero/
, identifier CRD42024513090.

Figures