Network meta-analysis compares prophylactic anticoagulants for central venous catheter-related thrombosis in cancer patients.

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Frontiers in Medicine Published April 19, 2026 Medically reviewed April 25, 2026 DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Note apixaban reduces CRT incidence versus no prophylaxis, but VKA increases bleeding risk; long-term safety data needed.

This Bayesian network meta-analysis evaluates prophylactic anticoagulation strategies for central venous catheter-related thrombosis in cancer patients. The review included 19 clinical studies comparing apixaban, vitamin K antagonists, rivaroxaban, and low-molecular-weight heparin against no prophylaxis. The primary outcome focused on central venous catheter-related thrombosis incidence, with secondary outcomes assessing bleeding risk, major bleeding, all-cause mortality, and adverse events.

Regarding thrombosis prevention, apixaban reduced central venous catheter-related thrombosis incidence compared with no prophylaxis, yielding an OR 0.31 with a 95% CI 0.17–0.54. Vitamin K antagonists, rivaroxaban, and low-molecular-weight heparin also showed significant reductions compared with no prophylaxis, though specific effect sizes were not reported for these comparisons. Conversely, vitamin K antagonists were associated with a higher bleeding risk than apixaban and no prophylaxis, with an OR 2.29 and a 95% CI 1.08–4.98. No significant differences were found among other treatments for major bleeding, all-cause mortality, or adverse events.

The authors note that long-term safety data from large-scale, multicenter trials are still needed to fully establish the safety profile of these interventions. Practice relevance suggests findings support the favorable effect of direct oral anticoagulants on central venous catheter-related thrombosis prevention. However, the search date extended up to 28 May 2025, and a bibliometric analysis included 680 publications, indicating a broad evidence base. Clinicians should interpret these results within the context of the included studies and acknowledge the limitations regarding long-term safety data.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedApr 2026

View Original Abstract ↓

BackgroundCatheter-related thrombosis (CRT) is a common complication following central venous catheter (CVC) placement in patients with cancer, increasing mortality and adverse outcomes. However, robust evidence on optimal prophylactic anticoagulation strategies remains limited.MethodsA bibliometric analysis was performed on English-language publications on CVC-associated thrombosis prevention in cancer patients indexed in the Web of Science (2000–2025). Descriptive analyses were conducted using the Bibliometrix package in R, with visualizations generated by VOSviewer and CiteSpace. For the network meta-analysis, clinical studies on prophylactic anticoagulation for CRT in cancer patients were systematically searched (up to 28 May 2025), and a Bayesian network meta-analysis was performed using R packages netmeta and gemtc.ResultsA total of 680 publications from 52 countries were identified. The United States led in both publication output and citations, and research focus shifted from warfarin and low-molecular-weight heparin (LMWH) toward direct oral anticoagulants (DOACs). Nineteen clinical studies were included in the network meta-analysis. Compared with no prophylaxis, apixaban reduced CRT incidence (OR 0.31, 95% CI 0.17–0.54), and vitamin K antagonists (VKA), rivaroxaban, and LMWH also showed significant reductions. VKA was associated with a higher bleeding risk than apixaban (OR 2.29, 95% CI 1.08–4.98) and no prophylaxis. No significant differences were found for major bleeding, all-cause mortality, or adverse events among other treatments.ConclusionApixaban, VKA, rivaroxaban, and LMWH effectively prevent CRT, while VKA is associated with an increased bleeding risk. These findings support the favorable effect of DOACs on CRT prevention. Long-term safety data from large-scale, multicenter trials are still needed.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD420251218825.