Dear Editor
Misleading citations in Guidelines are more of a concern rather than citation errors in individual papers. [1]. Due to exponential increase in publications, busy clinicians rely on Guidelines to distill the published evidence for their clinical practice. So any errors in Guidelines tend to have a disproportionate effect on patient care.
A 2020 paper published in New England Journal of Medicine (NEJM) has indicated that Apixaban can be safely used in cancer patients undergoing various Systemic therapies. [2].
But the 2021 European Heart Rhythm Association (EHRA) Practical Guide, which has indeed cited the NEJM paper, makes misleading recommendations on the use of Apixaban with various cancer drugs based on theoretical considerations. [3].
Specifically, the table 6 of the EHRA Guideline has a contraindication warning for use of Apixaban with anti-cancer agents such as Sunitinib, Imatinib, Enzalutamide, Doxorubicin and Vinblastine.
On the other hand, the NEJM paper clearly states that during the study recruitment “No anticancer therapy was excluded, which led to the inclusion of patients receiving a broad array of cytotoxic and biologic therapies”.
NEJM supplementary appendix and a follow on paper also specifically state that Sunitinib, Imatinib, Enzalutamide, Doxorubicin and Vinblastine were safely used in the study. (Table S2 and Table S3 NEJM appendix).[2] [4]
This 2021 EHRA Guideline is widely referenced by various NHS Guidelines. [5] [6]. Thus misleading citations in Guidelines are more likely to have a direct impact on patient care than individual papers.
References
1. Peoples N, Østbye T, Yan LL. Burden of proof: combating inaccurate citation in biomedical literature. BMJ 2023;383:e076441. doi:https://doi.org/10.1136/bmj-2023-076441
2. Agnelli G, Becattini C, Meyer G, et al. Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer. New England Journal of Medicine 2020;382:1599–607. doi:https://doi.org/10.1056/nejmoa1915103
3. Steffel J, Collins R, Antz M, et al. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace 2021;23:1612–76. doi:https://doi.org/10.1093/europace/euab065
4. Verso M, Munoz A, Bauersachs R, et al. Effects of concomitant administration of anticancer agents and apixaban or dalteparin on recurrence and bleeding in patients with cancer-associated venous thromboembolism. European Journal of Cancer 2021;148:371–81. doi:https://doi.org/10.1016/j.ejca.2021.02.026
5. Initiating a DOAC in Patients with Atrial Fibrillation / Flutter (AF). 2022. https://www.england.nhs.uk/north-west/wp-content/uploads/sites/48/2022/0… (accessed 14 Nov 2023).
6. SPS – Specialist Pharmacy Service. DOACs (Direct Oral Anticoagulants) monitoring. 2021.https://www.sps.nhs.uk/monitorings/doacs-direct-oral-anticoagulants-moni… (accessed 14 Nov 2023).
Misleading citations: Guidelines vs Individual Papers