Apixaban for the prevention and treatment of cancer-associated venous thromboembolism： a rapid health technology assessment

WANG Huayu; SHANGGUAN Keke; WANG Ying; LI Yankui

doi:10.6039/j.issn.1001-0408.2025.10.19

您当前的位置：

首页 >

文章列表页 >

Apixaban for the prevention and treatment of cancer-associated venous thromboembolism： a rapid health technology assessment

更新时间：2025-09-23

- Apixaban for the prevention and treatment of cancer-associated venous thromboembolism： a rapid health technology assessment
- ZHONGGUO YAOFANG Vol. 36, Issue 10, Pages: 1260-1265(2025)
- 作者机构：
  
  1.天津医科大学第二医院药学部，天津　300211
  2.天津医科大学第二医院血管外科，天津　300211
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2025.10.19
  CLC： R973+.2;R969.3
- Received：20 November 2024，
  
  Revised：2025-04-07，
  
  Accepted：07 April 2025，
  
  Published：30 May 2025
- 稿件说明：
移动端阅览
王华玉,上官可可,王莹,等.阿哌沙班预防和治疗肿瘤相关静脉血栓栓塞症的快速卫生技术评估 [J].中国药房,2025,36(10):1260-1265.

WANG Huayu,SHANGGUAN Keke,WANG Ying,et al.Apixaban for the prevention and treatment of cancer-associated venous thromboembolism： a rapid health technology assessment[J].ZHONGGUO YAOFANG,2025,36(10):1260-1265.
王华玉,上官可可,王莹,等.阿哌沙班预防和治疗肿瘤相关静脉血栓栓塞症的快速卫生技术评估 [J].中国药房,2025,36(10):1260-1265. DOI： 10.6039/j.issn.1001-0408.2025.10.19.

WANG Huayu,SHANGGUAN Keke,WANG Ying,et al.Apixaban for the prevention and treatment of cancer-associated venous thromboembolism： a rapid health technology assessment[J].ZHONGGUO YAOFANG,2025,36(10):1260-1265. DOI： 10.6039/j.issn.1001-0408.2025.10.19.

摘要

目的

评价阿哌沙班预防和治疗肿瘤相关静脉血栓栓塞症（CA-VTE）的有效性、安全性和经济性，为临床用药提供循证依据。

方法

检索PubMed、the Cochrane Library、中国知网、万方数据、维普网及卫生技术评估（HTA）相关网站，收集阿哌沙班预防和治疗CA-VTE的系统评价/Meta分析、药物经济学研究和HTA报告。经资料提取、质量评价后，对纳入研究的结果进行描述性分析。

结果

共纳入23篇文献，包括16篇系统评价/Meta分析和7篇药物经济学研究。有效性方面，与安慰剂比较，预防性应用阿哌沙班可显著降低门诊成年肿瘤患者的静脉血栓栓塞症（VTE）发生率（

＜0.05）；与低分子肝素（LMWH）、利伐沙班和华法林患者的VTE发生率比较，差异均无统计学意义（

＞0.05），但阿哌沙班排名最优。与使用华法林比较，阿哌沙班可显著降低CA-VTE患者的VTE复发率（

＜0.05）；与使用LMWH、利伐沙班、艾多沙班和达比加群患者的VTE复发率、深静脉血栓形成复发率和肺栓塞复发率比较，差异均无统计学意义（

＞0.05）。安全性方面，与安慰剂比较，预防性应用阿哌沙班的接受化疗门诊成年肿瘤患者的大出血发生率更高（

＜0.05），与使用LMWH、利伐沙班和华法林患者的大出血发生率比较，差异均无统计学意义（

＞0.05），但阿哌沙班排名最优。使用阿哌沙班与达肝素的CA-VTE患者的大出血发生率、全因死亡率比较，差异均无统计学意义（

＞0.05），但使用阿哌沙班患者的临床相关非大出血（CRNMB）发生率更高（

＜0.05）。与艾多沙班比较，使用阿哌沙班患者的大出血发生率显著降低（

＜0.05），但CRNMB发生率、临床相关出血发生率和全因死亡率比较，差异均无统计学意义（

＞0.05）。与利伐沙班、华法林和达比加群比较，使用阿哌沙班患者的大出血发生率、CRNMB发生率、临床相关出血发生率和全因死亡率比较，差异均无统计学意义（

＞0.05）。经济性方面，我国研究表明，阿哌沙班预防CA-VTE具有经济性；国外研究表明，阿哌沙班预防和治疗CA-VTE具有经济性。

结论

阿哌沙班预防和治疗CA-VTE具有良好的有效性、安全性和经济性。

Abstract

OBJECTIVE

To evaluate the efficacy， safety and cost-effectiveness of apixaban in the prevention and treatment of cancer-associated venous thromboembolism （CA-VTE）， and provide evidence-based reference for clinical treatment.

METHODS

Retrieved from PubMed， the Cochrane Library， CNKI， Wanfang， VIP database and other websites of health technology assessment （HTA）， systematic review/meta-analysis， pharmacoeconomic studies and HTA reports of apixaban in the prevention and treatment of CA-VTE were collected. After data extraction and quality evaluation， the results of the included study were analyzed descriptively.

RESULTS

A total of 23 literatures were included， involving 16 systematic review/meta-analysis and 7 pharmacoeconomic studies. In terms of efficacy， compared with placebo， prophylactic use of apixaban could significantly reduce the incidence of venous thromboembolism （VTE） in outpatient adult cancer patients receiving chemotherapy （

＜0.05）. Compared with low-molecular weight heparin （LMWH）， rivaroxaban and warfarin， there were no statistically significant differences in the incidence of VTE for apixaban （

＞0.05）； nevertheless， apixaban was ranked as the most preferable choice. For the treatment of patients with CA-VTE， compared with warfarin， apixaban could significantly reduce the recurrence rate of VTE （

＜0.05）. While compared with patients treated with LMWH， rivaroxaban， edoxaban and dabigatran， there were no statistically significant differences in the recurrence rates of VTE， deep venous thrombosis and pulmona

ry embolism among patients using apixaban （

＞0.05）. In terms of safety， compared with placebo， prophylactic use of apixaban showed a higher occurrence of major bleeding in outpatient adult cancer patients receiving chemotherapy （

＜0.05）， while compared with patients treated with LMWH， rivaroxaban， and warfarin， there were no statistically significant differences in the incidence of major bleeding among patients using apixaban （

＞0.05）； despite this， apixaban was ranked as the most favorable option. For the treatment of patients with CA-VTE， compared with dalteparin， the incidence of major bleeding and all-cause mortality of apixaban were similar （

＞0.05）， while the incidence of clinically relevant non-major bleeding （CRNMB） was higher （

＜0.05）. Compared with edoxaban， the incidence of major bleeding of apixaban was reduced significantly （

＜0.05）， while there was no significant difference in the incidence of CRNMB， the incidence of clinically relevant bleeding and all-cause mortality （

＞0.05）. Compared with rivaroxaban， warfarin and dabigatran， there were no significant differences in the incidence of major bleeding， the incidence of CRNMB， the incidence of clinically relevant bleeding and all-cause mortality （

＞0.05）. In terms of cost-effectiveness， the researches in China showed that apixaban was cost-effective in preventing CA-VTE； foreign studies showed that apixaban was cost-effective in preventing and treating CA-VTE.

CONCLUSIONS

Apixaban is effective， safe and cost-effective in the prevention and treatment of CA-VTE.

关键词

Keywords

references

PUURUNEN M K ， GONA P N ， LARSON M G ， et al . Epidemiology of venous thromboembolism in the Framingham heart study [J ] . Thromb Res ， 2016 ， 145 ： 27 - 33 .

SONG X J ， LIU Z L ， ZENG R ， et al . Treatment of venous thromboembolism in cancer patients：a systematic review and meta-analysis on the efficacy and safety of different direct oral anticoagulants（DOACs） [J ] . Ann Transl Med ， 2021 ， 9 （ 2 ）： 162 .

GROSSE S D ， NELSON R E ， NYARKO K A ， et al . The economic burden of incident venous thromboembolism in the United States：a review of estimated attributable healthcare costs [J ] . Thromb Res ， 2016 ， 137 ： 3 - 10 .

中国临床肿瘤学会指南工作委员会组织 . 中国临床肿瘤学会（CSCO）肿瘤患者静脉血栓防治指南2024 [M ] . 北京：人民卫生出版社， 2024 ： 31 - 48 .

AGNELLI G ， BECATTINI C ， MEYER G ， et al . Apixaban for the treatment of venous thromboembolism associated with cancer [J ] . N Engl J Med ， 2020 ， 382 （ 17 ）： 1599 - 1607 .

HUSSAIN M R ， ALI F S ， VERGHESE D ， et al . Factor Xa inhibitors versus low molecular weight heparin for the treatment of cancer associated venous thromboembolism；A meta-analysis of randomized controlled trials and non-randomized studies [J ] . Crit Rev Oncol Hematol ， 2022 ， 169 ： 103526 .

FREDMAN D ， MCNEIL R ， ELDAR O ， et al . Efficacy and safety of rivaroxaban versus apixaban for venous thromboembolism：a systematic review and meta-analysis of observational studies [J ] . J Thromb Thrombolysis ， 2024 ， 57 （ 3 ）： 453 - 465 .

嵇承栋，朱琳懿，万悦竹，等 . 国际卫生技术评估机构协作网卫生技术评估报告清单解读 [J ] . 中国循证医学杂志， 2016 ， 16 （ 3 ）： 369 - 372 .

熊俊，陈日新 . 系统评价/Meta分析方法学质量的评价工具AMSTAR [J ] . 中国循证医学杂志， 2011 ， 11 （ 9 ）： 1084 - 1089 .

HUSEREAU D ， DRUMMOND M ， AUGUSTOVSKI F ， et al . Consolidated Health Economic Evaluation Repor-ting Standards 2022（CHEERS 2022）statement：updated reporting guidance for health economic evaluations [J ] . Value Health ， 2022 ， 25 （ 1 ）： 3 - 9 .

AMIN A ， NAEEM M O ， AMIN L ， et al . Apixaban versus low molecular weight heparin in patients with cancer-associated venous thromboembolism：a systematic review and meta-analysis [J ] . Ann Med Surg（Lond）， 2024 ， 86 （ 8 ）： 4675 - 4683 .

FUJISAKI T ， SUETA D ， YAMAMOTO E ， et al . Com-paring anticoagulation strategies for venous thromboembolism associated with active cancer：a systematic review and meta-analysis [J ] . JACC CardioOncol ， 2024 ， 6 （ 1 ）： 99 - 113 .

李雪梅，徐文坚，卢铨广 . 新型口服抗凝药治疗肿瘤相关静脉血栓栓塞症网状Meta分析 [J ] . 中国药业， 2024 ， 33 （ 1 ）： 116 - 122 .

NING H Y ， YANG N N ， DING Y Y ， et al . Efficacy and safety of direct oral anticoagulants for the treatment of cancer-associated venous thromboembolism：a systematic review and Bayesian network meta-analysis [J ] . Med Clin（Barc）， 2023 ， 160 （ 6 ）： 245 - 252 .

李朋，何虎强，陈豪，等 . 阿哌沙班治疗和预防癌症相关静脉血栓栓塞症的疗效与安全性的Meta分析 [J ] . 中华血管外科杂志， 2023 ， 8 （ 4 ）： 354 - 361 .

ARCE-HUAMANI M A ， BARBOZA J J ， MARTÍNEZ-HERRERA J F ， et al . Efficacy and safety of apixaban versus dalteparin as a treatment for cancer-associated venous thromboembolism：a systematic review and meta-analysis [J ] . Medicina（Kaunas）， 2023 ， 59 （ 10 ）： 1867 .

BALOCH M F ， ADEPOJU A V ， FALKI V ， et al . Comparative efficacy of oral apixaban and subcutaneous low molecular weight heparins in the treatment of cancer-associated thromboembolism：a meta-analysis [J ] . Cureus ， 2023 ， 15 （ 8 ）： e43447 .

SAMARANAYAKE C B ， ANDERSON J ， MCCABE C ， et al . Direct oral anticoagulants for cancer-associated venous thromboembolisms：a systematic review and network meta-analysis [J ] . Intern Med J ， 2022 ， 52 （ 2 ）： 272 - 281 .

RIAZ I B ， FUENTES H E ， NAQVI S A A ， et al . Direct oral anticoagulants compared with dalteparin for treatment of cancer-associated thrombosis：a living，interactive systematic review and network meta-analysis [J ] . Mayo Clin Proc ， 2022 ， 97 （ 2 ）： 308 - 324 .

WU S Y ， LV M N ， CHEN J N ， et al . Direct oral anticoagulants for venous thromboembolism in cancer patients：a systematic review and network meta-analysis [J ] . Support Care Cancer ， 2022 ， 30 （ 12 ）： 10407 - 10420 .

BRANDÃO G M S ， MALGOR R D ， VIECELI T ， et al . A network meta-analysis of direct factor Ⅹa inhibitors for the treatment of cancer-associated venous thromboembolism [J ] . Vascular ， 2022 ， 30 （ 1 ）： 130 - 145 .

UEYAMA H ， MIYASHITA H ， TAKAGI H ， et al . Network meta-analysis of anticoagulation strategies for venous thromboembolism in patients with cancer [J ] . J Thromb Thrombolysis ， 2021 ， 51 （ 1 ）： 102 - 111 .

CAPUTO R ， PYLE J ， KURIAKOSE P ， et al . A systematic review of apixaban in prevention and treatment of cancer-associated venous thromboembolism [J ] . J Am Pharm Assoc （2003）， 2021 ， 61 （ 5 ）： e26 - e38 .

YAN Y D ， DING Z ， PAN M M ， et al . Net clinical benefit of direct oral anticoagulants in patients with cancer and venous thromboembolism：a systematic review and trade-off analysis [J ] . Front Cardiovasc Med ， 2020 ， 7 ： 586020 .

XIN Z C ， LIU F ， DU Y ， et al . Primary prophylaxis for venous thromboembolism in ambulatory cancer patients：a systematic review and network meta-analysis [J ] . Ann Palliat Med ， 2020 ， 9 （ 5 ）： 2970 - 2981 .

FUENTES H E ， MCBANE R D ， WYSOKINSKI W E ， et al . Direct oral factor Ⅹa inhibitors for the treatment of acute cancer-associated venous thromboembolism：a systematic review and network meta-analysis [J ] . Mayo Clin Proc ， 2019 ， 94 （ 12 ）： 2444 - 2454 .

WU Y ， YIN T C ， JIAN G L ， et al . Cost-effectiveness analysis of direct oral anticoagulants versus low-molecular-weight heparin and no thromboprophylaxis in primary prevention of cancer-associated venous throm-boembolism in China [J ] . Front Pharmacol ， 2024 ， 15 ： 1373333 .

GULATI S ， ECKMAN M H . Anticoagulant therapy for cancer-associated thrombosis：a cost-effectiveness analysis [J ] . Ann Intern Med ， 2023 ， 176 （ 1 ）： 1 - 9 .

BELL S ， ORELLANA T ， GARRETT A ， et al . Prophylactic anticoagulation after minimally invasive hysterectomy for endometrial cancer：a cost-effectiveness analysis [J ] . Int J Gynecol Cancer ， 2023 ， 33 （ 12 ）： 1875 - 1881 .

MUÑOZ A J ， ORTEGA L ， GUTIÉRREZ A ， et al . Cost-effectiveness of apixaban and rivaroxaban in thromboprophylaxis of cancer patients treated with chemotherapy in Spain [J ] . J Med Econ ， 2023 ， 26 （ 1 ）： 1145 - 1154 .

MUÑOZ A ， GALLARDO E ， AGNELLI G ， et al . Cost-effectiveness of direct oral anticoagulants compared to low-molecular-weight-heparins for treatment of cancer associated venous thromboembolism in Spain [J ] . J Med Econ ， 2022 ， 25 （ 1 ）： 840 - 847 .

KIMPTON M ， KUMAR S ， WELLS P S ， et al . Cost-utility analysis of apixaban compared with usual care for primary thromboprophylaxis in ambulatory patients with cancer [J ] . CMAJ ， 2021 ， 193 （ 40 ）： E1551 - E1560 .

GLICKMAN A ， BRENNECKE A ， TAYEBNEJAD A ， et al . Cost-effectiveness of apixaban for prevention of venous thromboembolic events in patients after gynecologic cancer surgery [J ] . Gynecol Oncol ， 2020 ， 159 （ 2 ）： 476 - 482 .

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Rapid health technology assessment of serplulimab in the first-line treatment of small-cell lung cancer

Rapid health technology assessment of tirzepatide for diabetes mellitus type 2 and long-term weight management

钙离子通道调节剂治疗糖尿病周围神经病理性疼痛的快速卫生技术评估

Rapid health technology assessment of the efficacy， safety and cost-effectiveness of vericiguat in the treatment of heart failure

Semaglutide in the treatment of type 2 diabetes mellitus： rapid health technology assessment

Related Author

LIU Huanlong

NIE Ying

WANG Xiaohui

GONG Yuan

KANG Shuo

HOU Yibing

CAO Weiling

ZHENG Guimei

Related Institution

School of Pharmacy， Hebei Medical University

Medical Insurance Office， the Second Hospital of Hebei Medical University

Dept. of Pharmacy，the Second Hospital of Hebei Medical University

School of Public Health， Southern Medical University

Dept. of Pharmacy， Shenzhen Luohu District People’s Hospital

⁰