癌症患者发生静脉血栓栓塞 (VTE) 的风险比普通人群高四到七倍。新型口服抗凝剂 (NOAC) 为传统疗法提供了便捷的替代方案。我们在 PubMed、Embase 和 Cochrane 图书馆进行了系统的文献检索，针对检查 NOAC 在癌症相关 VTE 中的使用的研究。搜索包括随机对照试验（RCT）。选定的研究将 NOAC 与低分子量肝素 (LMWH) 或维生素 K 拮抗剂 (VKA) 在诊断为 VTE 的癌症患者中进行比较。使用随机效应模型的荟萃分析用于估计结果的汇总效应大小。在这项荟萃分析中，我们纳入了 12 项随机对照试验。结果显示，NOAC 在预防 VTE 复发方面比 LMWH 更有效（RR 0.66，95% CI 0.52-0.83，p = 0.0004）。与 VKA 相比，NOAC 没有显着差异（RR 0.63，95% CI 0.34-1.15，p = 0.13）。然而，这一发现受到患者样本较小的限制。 NOAC 和 LMWH/VKA 之间的大出血结局相似（分别为 RR 1.24，95% CI 0.85-1.80，p = 0.28；RR 0.77，95% CI 0.39-1.53​​，p = 0.46）。荟萃回归分析表明，当将 NOAC 与 LMWH 进行比较时，死亡率和主要出血事件之间存在统计学上显着的正相关性 (p = 0.049)。接受 NOAC 治疗的患者与接受 LMWH（RR 1.04，95% CI 0.92-1.18，p = 0.54）或 VKA（RR 0.94，95% CI 0.72-1.23，p = 0.65)。荟萃分析显示，NOAC，尤其是 Xa 因子抑制剂，比 LMWH 更有效地减少癌症患者的 VTE 复发。由于患者数据有限，NOAC 和 VKA 之间的比较尚无定论。需要进一步研究来评估 NOAC 对抗 VKA 的功效和安全性。© 2024。作者获得 Springer Science Business Media, LLC（Springer Nature 旗下公司）的独家许可。

Cancer patients face a four- to sevenfold higher risk of venous thromboembolism (VTE) than the general population. Novel oral anticoagulants (NOACs) provide convenient alternatives to traditional therapies.We performed a systematic literature search across PubMed, Embase, and the Cochrane Library, targeting studies that examined the use of NOACs in cancer-associated VTE. The search included randomized controlled trials (RCTs). Selected studies compared NOACs with low-molecular-weight heparin (LMWH) or vitamin K antagonists (VKA) in cancer patients diagnosed with VTE. A meta-analysis using a random-effects model was applied to estimate pooled effect sizes for outcomes.In this meta-analysis, we included 12 RCTs. Results showed NOACs were more effective than LMWH in preventing VTE recurrence (RR 0.66, 95% CI 0.52-0.83, p = 0.0004). Compared with VKAs, NOACs showed no significant difference (RR 0.63, 95% CI 0.34-1.15, p = 0.13). However, this finding is limited by the small patient sample. Major bleeding outcomes were similar between NOACs and LMWH/VKAs (RR 1.24, 95% CI 0.85-1.80, p = 0.28; RR 0.77, 95% CI 0.39-1.53, p = 0.46, respectively). Meta-regression analysis indicated a statistically significant positive correlation between mortality and major bleeding events when comparing NOACs with LMWH (p = 0.049). There was no significant difference in all-cause mortality between patients treated with NOACs and those treated with LMWH (RR 1.04, 95% CI 0.92-1.18, p = 0.54) or VKAs (RR 0.94, 95% CI 0.72-1.23, p = 0.65).Meta-analysis shows NOACs, especially factor Xa inhibitors, reduce VTE recurrence in cancer patients more effectively than LMWH. Comparison between NOACs and VKAs is inconclusive due to limited patient data. Further research is needed to assess NOACs' efficacy and safety against VKAs.© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.