Bhusal, Suzit

Background and aims: Traditionally, low molecular weight heparin, such as dalteparin, has been the first-line treatment for cancer-associated venous thromboembolism (VTE). However, recent studies suggest that rivaroxaban, a direct oral anticoagulant, may offer comparable efficacy with the convenience of oral administration. This systematic review and meta-analysis aim to evaluate and compare the efficacy and safety of rivaroxaban versus dalteparin in managing cancer-associated VTE, focusing on recurrence rates, bleeding events, and patient adherence. Methods: This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines, systematically retrieving data from PubMed and Cochrane databases using structured search terms related to cancer, VTE, and anticoagulation. Data on recurrent VTE, major bleeding, and patient outcomes were extracted. Statistical analyses were performed using a random-effects model to account for heterogeneity. Results: Nine studies were analyzed, encompassing a range of study designs across multiple countries. The findings show no significant difference in major bleeding risk between rivaroxaban and dalteparin (risk ratio: 0.91, P = 0.69), nor in bleeding-related mortality (odds ratio [OR]: 4.00, P = 0.36). Rivaroxaban was associated with a significant reduction in deep vein thrombosis (DVT) recurrence (OR: 0.75, P = 0.04) and a marginally nonsignificant reduction in pulmonary embolism recurrence (OR: 0.73, P = 0.05). Nonsignificant bleeding events were slightly higher with rivaroxaban but did not reach statistical significance. Conclusion: Rivaroxaban presents a viable alternative to dalteparin for treating cancer-associated VTE, showing comparable safety regarding major bleeding and potential efficacy in reducing DVT recurrence. This study supports the potential for more standardized guidelines that include rivaroxaban as a feasible option in cancer-associated VTE management.