Impact of P2Y12 inhibitors on clinical outcomes in sepsis-3 patients receiving aspirin: a propensity score matched analysis.

BACKGROUND: Sepsis is a life-threatening disease accompanied by disorders of the coagulation and immune systems. P2Y12 inhibitors, widely used for arterial thrombosis prevention and treatment, possess recently discovered anti-inflammatory properties, raising potential for improved sepsis prognosis. METHOD: We conducted a retrospective analysis using the data from Medical Information Mart for Intensive Care-IV database. Patients were divided into an aspirin-alone group versus a combination group based on the use of a P2Y12 inhibitor or not. Differences in 30-day mortality, length of stay (LOS) in intensive care unit (ICU), LOS in hospital, bleeding events and thrombotic events were compared between the two groups. RESULT: A total of 1701 pairs of matched patients were obtained by propensity score matching. We found that no statistically significant difference in 30-day mortality in aspirin-alone group and combination group (15.3% vs. 13.7%, log-rank p = 0.154). In addition, patients received P2Y12 inhibitors had a higher incidence of gastrointestinal bleeding (0.5% vs. 1.6%, p = 0.004) and ischemic stroke (1.7% vs. 2.9%, p = 0.023), despite having a shorter LOS in hospital (11.1 vs. 10.3, days, p = 0.043). Cox regression showed that P2Y12 inhibitor was not associated with 30-day mortality (HR = 1.14, 95% CI 0.95-1.36, p = 0.154). CONCLUSION: P2Y12 inhibitors did not provide a survival benefit for patients with sepsis 3 and even led to additional adverse clinical outcomes.

Internet of Things (IoT)-enabled framework for a sustainable Vaccine cold chain management system.

Vaccines are a unique category of drugs sensitive to temperature and humidity and whose effectiveness directly impacts public health. There has been an increase in vaccine-related adverse events worldwide, particularly in developing countries, attributed to suboptimal temperatures during transport and storage. At the same time, the Internet of Things (IoT) has ushered in a paradigm shift in vaccine information and storage monitoring, enabling continuous 24/7 tracking. This further reduces the dependence on limited human resources and significantly reduces the associated errors and losses. This paper presents an IoT-driven framework that aims to improve the sustainability of medical cold chain management. The framework promotes trust and transparency in vaccine surveillance data by accessing and authenticating IoT devices. The proposed system aims to improve the safety and sustainability of vaccine management. Moreover, we provide detailed insights into the design and hardware components of the proposed framework. In addition, the specific use of the framework in a particular province is highlighted, covering the design of the software platform and the analysis of the hardware equipment.

Effects of BC on metal uptake by crops (availability) and the vertical migration behavior in soil: A 3-year field experiments of crop rotation.

Biochar (BC) has been substantiated to effectively reduce the available content of heavy metals (HMs) in soil-plant system; however, the risk of biochar (BC)derived dissolved organic matter (DOM) induced metal vertical migration has not been well documented, especially in the long-term field conditions. Therefore, this study investigated HM vertical migration ecological risks and the long-term effectiveness of the amendment of biochar in the three successive years of field trials during the rotation system. The results revealed that biochar application could increase soil pH and DOM with a decrease in soil CaCl2 extractable pool for Pb, Cu, and Cd. Furthermore, the results indicated a significant decrease in acid phosphatase activities and an increase in urease and catalase activities in the soil. Cucumber was shown to be safe during a three-year rotation system in the field. These results suggest that BC has the potential to enhance soil environment and crop yields. BC derived DOM-specific substances were identified using parallel factor analysis of excitation-emission matrix in deep soil (0-60 cm). The study incorporated HM concentration fluctuations in deep soils, providing an additional interpretation of DOM and co-migration of HMs.The environmental risk associated with the increase in DOM hydrophobicity should not be ignored by employing BC for soil HM remediation applications. The study enhances understanding of biochar-derived DOM's migration and stabilization mechanisms on heavy metals, providing guidelines for its use as a soil amendment.

High-performance magnetic metal microrobot prepared by a two-photon polymerization and sintering method.

Magnetically-actuated microrobots (MARs) exhibit great potential in biomedicine owing to their precise navigation, wireless actuation and remote operation in confined space. However, most previously explored MARs unfold the drawback of hypodynamic magnetic torque due to low magnetic content, leading to their limited applications in controlled locomotion in fast-flowing fluid and massive cargo carrying to the target position. Here, we report a high-performance pure-nickel magnetically-actuated microrobot (Ni-MAR), prepared by a femtosecond laser polymerization followed by sintering method. Our Ni-MAR possesses a high magnetic content (∼90 wt%), thus resulting in enhanced magnetic torque under low-strength rotating magnetic fields, which enables the microrobot to exhibit high-speed swimming and superior cargo carrying. The maximum velocity of our Ni-MAR, 12.5 body lengths per second, outperforms the velocity of traditional helical MARs. The high-speed Ni-MAR is capable of maintaining controlled locomotion in fast-flowing fluid. Moreover, the Ni-MAR with massive cargo carrying capability can push a 200-times heavier microcube with translation and rotation motion. A single cell and multiple cells can be transported facilely by a single Ni-MAR to the target position. This work provides a scheme for fabricating high-performance magnetic microrobots, which holds great promise for targeted therapy and drug delivery in vivo.

nFeS Embedded into Cryogels for High-Efficiency Removal of Cr(VI): From Mechanism to for Treatment of Industrial Wastewater.

Most studies have focused on complex strategies for materials preparation instead of industrial wastewater treatment due to emergency treatment requirements for metal pollution. This study evaluated sodium polyacrylate (PSA) as a carbon skeleton and FeS as a functional material to synthesize PSA-nFeS material. The characteristics and interactions of PSA-nFeS composites treated with hexavalent chromium were analyzed by means of various techniques, such as scanning electron microscopy-energy dispersive X-ray spectrometry (SEM-EDS), X-ray photoelectron spectroscopy (XPS), Fourier transform infrared spectrometry (FTIR), and atomic absorption spectroscopy (AAS). Adsorption-coupled reduction was observed to be the predominant mechanism of Cr(VI) removal. The feasibility of PSA-nFeS composites in reducing toxicity and removing of Cr(VI) from real effluents was investigated through column studies and material properties evaluation. The continuous column studies were conducted using tannery effluents to optimize feed flow rates, initial feed Cr(VI) concentration, and column bed height. The results revealed that PSA-nFeS composites are ideal for filling materials in portable filtration devices due to their lightweight and compact size.

Three-year field experiments revealed the immobilization effect of natural aging biochar on typical heavy metals (Pb, Cu, Cd).

Biochar has been widely used for the remediation of heavy metal contaminated soil, while the long-term field aging on its properties and the performance in the ability of metal immobilization must not be overlooked. In this study, the stability of immobilized heavy metals (Cd, Cu, Pb) on biochar during a 3-year remediation for soil in the field was investigated through desorption experiments. The results indicated that the application of biochar and its aging in the field both remarkably increased the immobilization of the 3 metal ions in the field under 3-year remediation. The cumulative desorption of the 3 metals decreased with biochar aging, and the desorption rate of Pb2+, Cu2+ and Cd2+ in T3 (Application of 30 t·hm-2 of biochar) for the third year was 0.08 %, 0.20 % and 13.15 %. Meanwhile, both the desorption rates and extents exhibited significant difference with the order of Pb2+ < Cu2+ < Cd2+. The increased soil pH, the enhancement of O/C ratio (Increase from 0.30 for fresh BC to 0.61 for aged BC(S3)) and oxygen-containing functional groups in biochar, and the accretion of organo-mineral micro-agglomerates on biochar surfaces and in pores during field aging process jointly contributed the immobilization of metals in soils mainly through co-precipitation and complexation. Our results provide new insights into the practical application of biochar in soils contaminated with multiple heavy metals from the perspective of long-term effects, which suggests that the potential release risk of metals become slighter over time.

Magnetic Janus origami robot for cross-scale droplet omni-manipulation.

The versatile manipulation of cross-scale droplets is essential in many fields. Magnetic excitation is widely used for droplet manipulation due to its distinguishing merits. However, facile magnetic actuation strategies are still lacked to realize versatile multiscale droplet manipulation. Here, a type of magnetically actuated Janus origami robot is readily fabricated for versatile cross-scale droplet manipulation including three-dimensional transport, merging, splitting, dispensing and release of daughter droplets, stirring and remote heating. The robot allows untethered droplet manipulation from ~3.2 nL to ~51.14 µL. It enables splitting of droplet, precise dispensing (minimum of ~3.2 nL) and release (minimum of ~30.2 nL) of daughter droplets. The combination of magnetically controlled rotation and photothermal properties further endows the robot with the ability to stir and heat droplets remotely. Finally, the application of the robot in polymerase chain reaction (PCR) is explored. The extraction and purification of nucleic acids can be successfully achieved.

Water flow promoted charge separation in piezoelectric Bi4Ti3O12 for the enhanced photocatalytic degradation of antibiotic.

Addressing the issue of antibiotic residues in the environment is key to improving the quality of aquatic environments and reducing human health risks. In this study, piezoelectric bismuth titanate (Bi4Ti3O12) nanosheets are synthesized and employed to conduct antibiotic degradation. The piezoelectric potential induced by the water flow shear force is utilized to facilitate charge separation and migration in the photocatalytic process and enhance the catalytic degradation of antibiotic wastewater. As a result, 85% of tetracycline hydrochloride (TC) is degraded within 90 min. The piezo-photocatalytic process exhibits a 2.4 times faster reaction rate and a 15% higher mineralization rate than photocatalysis. Different environmental factors are investigated for their effects on the catalytic activity in piezo-photocatalysis. In situ electrochemical measurement and photoluminescence (PL) spectroscopy under stress demonstrated that the piezoelectric potential shifted the energy band of Bi4Ti3O12 and promoted the charge migration and separation, which produce more active species that favor the efficient catalytic degradation. Finally, the intermediate products of the tetracycline hydrochloride degradation process are analyzed and possible degradation pathways are suggested. This study elucidates the degradation mechanism of Bi4Ti3O12 as a piezo-photocatalyst for antibiotic pollutants, and meticulously investigates the charge transfer mechanism of the catalyst material in response to micro-stress. Hence, it provides an efficient solution for organic wastewater treatment and can potentially provide theoretical support for the development and performance optimization of catalyst materials applied in natural environments.

Enhanced nitrogen removal in immersed rotating self-aerated biofilm reactor: Nitrogen removal pathway and microbial mechanism.

To achieve energy-efficient treatment of the rural wastewater with satisfying performance, a novel immersed rotating self-aerated biofilm reactor (iRSABR) was proposed in this study. The iRSABR system showed better biofilm renewal performance and higher microbial activity. The effect of different regulation strategies on the iRSABR system was investigated in this study. The 70% immersion ratio and 4 r/min rotation speed (stage III) exhibited the best performance, with a total nitrogen removal efficiency of 86% and a simultaneous nitrification-denitrification (SND) rate of 76%, along with the highest electron transport system activity. The nitrogen removal pathway revealed that the SND was achieved through autotrophic/heterotrophic nitrification and aerobic/anoxic denitrification. The regulation strategy in the iRSABR system established a synergistic microbial community with main functional bacteria of nitrification (Nitrosomonas), anoxic denitrification (Flavobacterium, Pseudoxanthomonas), and aerobic denitrification (Thauera). This study highlighted the feasibility and adaptability of the iRSABR system toward energy-efficient rural wastewater treatment.

Geometry-Gradient Magnetocontrollable Lubricant-Infused Microwall Array for Passive/Active Hybrid Bidirectional Droplet Transport.

Manipulation of droplets has increasingly garnered global attention, owing to its multifarious potential applications, including microfluidics and medical diagnostic tests. To control the droplet motion, geometry-gradient-based passive transport has emerged as a well-established strategy, which induces a Laplace pressure difference based on the droplet radius differences in confined state and transport droplets with no consumption of external energy, whereas this transportation method has inevitably shown some critical limitations: unidirectionality, uncontrollability, short moving distance, and low velocity. Herein, a magnetocontrollable lubricant-infused microwall array (MLIMA) is designed as a key solution to this issue. In the absence of a magnetic field, droplets can spontaneously travel from the tip toward the root of the structure as a result of the geometry-gradient-induced Laplace pressure difference. When the subject of an external magnetic field, the microwalls bend and overlap sequentially, ultimately resulting in the formation of a continuous slippery meniscus surface. The formed meniscus surface can exert sufficient propulsive force to surmount the Laplace pressure difference of the droplet, thereby effectuating active transport. Through the continuous movement of the microwalls, droplets can be actively transported against the Laplace pressure difference from the root to the tip side of the MLIMA or continue to actively move to the root after finishing the passive self-transport. This work demonstrates passive/active hybrid bidirectional droplet transport capabilities, validates its feasibility in the accurate control of droplet manipulation, and exhibits great potential in chemical microreactions, bioassays, and the medical field.

Global burden of cardiovascular disease attributable to metabolic risk factors, 1990-2019: an analysis of observational data from a 2019 Global Burden of Disease study.

OBJECTIVES: An up-to-date, detailed global analysis of the current status of the metabolic-attributed cardiovascular disease (CVD) burden has not been reported. Therefore, we investigated the global burden of metabolic-attributed CVD and its association with socioeconomic development status over the past 30 years. METHODS: Data on the burden of metabolic-attributed CVD were taken from the 2019 Global Burden of Disease (GBD) study. Metabolic risk factors of CVD included high fasting plasma glucose, high low-density lipoprotein cholesterol (LDL-c), high systolic blood pressure (SBP), high body mass index (BMI) and kidney dysfunction. Numbers and age-standardised rates (ASR) of disability-adjusted life-years (DALYs) and deaths were extracted and stratified by sex, age, Socio-demographic Index (SDI) level, country and region. RESULTS: The ASR of metabolic-attributed CVD DALYs and deaths decreased by 28.0% (95% UI 23.8% to 32.5%) and 30.4% (95% UI 26.6% to 34.5%), respectively, from 1990 to 2019. The highest burden of metabolic-attributed total CVD and intracerebral haemorrhage was mainly in low SDI locations, while the highest burden of ischaemic heart disease and IS was mainly in high SDI locations. The burden of DALYs and deaths in CVD was higher in men than women. In addition, the number and ASR of DALYs and deaths were highest in those over 80 years old. CONCLUSION: Metabolic-attributed CVD threatens public health, especially in low-SDI locations and among the elderly. Low SDI location should strengthen the control of metabolic factors such as high SBP, high BMI, and high LDL-c and increase the knowledge of metabolic risk factors for CVD. Countries and regions should enhance screening and prevention of metabolic risk factors of CVD in the elderly. Policy-makers should use 2019 GBD data to guide cost-effective interventions and resource allocation.

High-performance Marangoni hydrogel rotors with asymmetric porosity and drag reduction profile.

Miniaturized rotors based on Marangoni effect have attracted great attentions due to their promising applications in propulsion and power generation. Despite intensive studies, the development of Marangoni rotors with high rotation output and fuel economy remains challenging. To address this challenge, we introduce an asymmetric porosity strategy to fabricate Marangoni rotor composed of thermoresponsive hydrogel and low surface tension anesthetic metabolite. Combining enhanced Marangoni propulsion of asymmetric porosity with drag reduction of well-designed profile, our rotor precedes previous studies in rotation output (~15 times) and fuel economy (~34% higher). Utilizing thermoresponsive hydrogel, the rotor realizes rapid refueling within 33 s. Moreover, iron-powder dopant further imparts the rotors with individual-specific locomotion in group under magnetic stimuli. Significantly, diverse functionalities including kinetic energy transmission, mini-generator and environmental remediation are demonstrated, which open new perspectives for designing miniaturized rotating machineries and inspire researchers in robotics, energy, and environment.

Severe Bleeding Risk of Direct Oral Anticoagulants Versus Vitamin K Antagonists for Stroke Prevention and Treatment in Patients with Atrial Fibrillation: A Systematic Review and Network Meta-Analysis.

PURPOSE: We aimed to determine the safety of direct oral anticoagulants (DOACs) for stroke prevention and treatment in patients with atrial fibrillation (AF). METHODS: A systematic search of four databases (PubMed, EMBASE, Web of Science, and Cochrane Library) was performed to identify randomized controlled trials (RCTs) reporting severe bleeding events in patients taking DOACs or vitamin K antagonists (VKAs). In this frequency-based network meta-analysis, odds ratios and 95% confidence intervals were used for reporting. Based on the surface under the cumulative ranking curves (SUCRA), the relative ranking probability of each group was generated. RESULTS: Twenty-three RCTs met the inclusion criteria, and a total of 87,616 patients were enrolled. The bleeding safety of DOACs for stroke prevention and treatment in patients with AF was ranked from highest to lowest as follows: fatal bleeding: edoxaban (SUCRA,80.2), rivaroxaban (SUCRA,68.3), apixaban (SUCRA,48.5), dabigatran (SUCRA,40.0), VKAs (SUCRA,12.9); major bleeding: dabigatran (SUCRA,74.0), apixaban (SUCRA,71.5), edoxaban (SUCRA,66.5), rivaroxaban (SUCRA,22.7), VKAs (SUCRA,15.4); gastrointestinal bleeding: apixaban (SUCRA,55.9), VKAs (SUCRA,53.7), edoxaban (SUCRA,50.5), rivaroxaban (SUCRA,50.4), dabigatran (SUCRA,39.5); intracranial hemorrhage: dabigatran (SUCRA,84.6), edoxaban (SUCRA,74.1), apixaban (SUCRA,65.8), rivaroxaban (SUCRA,24.4), VKAs (SUCRA,1.1). CONCLUSION: Based on current evidence, for stroke prevention and treatment in patients with AF, the most safe DOAC is edoxaban in terms of fatal bleeding; dabigatran in terms of major bleeding and intracranial hemorrhage and apixaban in terms of gastrointestinal bleeding. However, given the nature of indirect comparisons, more high-quality evidence from head-to-head comparisons is still needed to confirm them.

Association between Body Mass Index and Clinical Outcomes in Patients with Non-valvular Atrial Fibrillation Receiving Direct Oral Anticoagulants: A New Piece of Evidence on the Obesity Paradox from China.

PURPOSE: We conducted a multicenter real-world study in China to assess the association between body mass index (BMI) and clinical outcomes in patients with atrial fibrillation (AF) taking direct oral anticoagulants (DOACs). METHOD: This is a retrospective multicenter cohort study conducted in 15 centers in China. We collected demographic information through the hospital information system and obtained clinical events through follow-up visits to patients or relatives. Clinical outcomes include major, minor, total bleeding, thromboembolism, and all-cause death. RESULT: A total of 6164 patients with non-valvular AF (NVAF) were included in this study. The incidence of major bleeding in patients with NVAF differed significantly by BMI category (P < 0.001), with 5.2% in the underweight group, 2.6% in the normal group, 1.4% in the overweight group, 1.1% in the obese I group, and 1.3% in the obese II group. There was no significant difference in minor, total bleeding, and thrombosis in the five groups (P = 0.493; P = 0.172; P = 0.663). All-cause death was significantly different among the five groups (P < 0.001), with 8.9% in the underweight group, 6.3% in the normal group, 4.8% in the overweight group, 2.2% in the obese I group, and 0.4% in the obese II group. High BMI was negatively associated with major bleeding (OR = 0.353, 95% CI 0.205-0.608), total bleeding (OR = 0.664, 95% CI 0.445-0.991), and all-cause death (OR = 0.370, 95% CI 0.260-0.527). CONCLUSION: In patients with NVAF treated with DOACs, higher BMI was associated with lower major bleeding and better survival. BMI was a negative correlate of total bleeding, but not minor bleeding and thrombosis.

The preparation of paddy soil amendment using granite and marble waste: Performance and mechanisms.

The wastes generated from the mining and processing of granite and marble stone are generally regarded as useless. However, these waste materials were used as the soil amendments for the first time. The functional groups, crystalline structure and micro-morphology of granite and marble wastes amendments (GMWA) were different from the original wastes demonstrated by X-ray diffractometer (XRD), Fourier transform infrared spectrometer (FT-IR) and Scanning electron microscope-energy dispersive spectrometer (SEM-EDS) analyses. With the addition of the amendments, the cation exchange capacity, electrical conductivity and nutrient availability of the soil increased, and the extractable heavy metals of the soil reduced significantly. Under the condition of the addition of 3% amendments, 7.0%, 99.9%, 99.7% and 70.5% of Cu, Pb, Zn and Cd in exchangeable fractions in soil were transformed to the more stable Fe-Mn oxides- or carbonates-bounded fractions. Tessier method and correlation analysis showed that the reduction of extractable metals in the acidic paddy soil can be attributed to the adsorption of available SiO2, the co-precipitation induced by the elevated pH value, the complexation induced by Fe-Mn oxides and the cation exchange induced by mineral nutrients. This study provides a new strategy for resource recovery of waste stones and remediation of heavy metal-contaminated soil.

A new model to predict the risk of major gastrointestinal bleeding in patients on direct oral anticoagulants (dabigatran and rivaroxaban).

AIMS: The aim of this study was to identify factors associated with gastrointestinal bleeding (GIB) in patients on direct oral anticoagulants (DOACs) and develop a risk score that would provide an effective tool for the clinical assessment of GIB. METHODS: This was a multicentre retrospective analysis of clinical and follow-up data of patients treated with DOACs. The score was developed through logistic regression. The performance of score was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity and Hosmer-Lemeshow test. RESULTS: The 11 903 patients had a mean age of 65.1 years. In multivariate analysis, age ≥65 years, alcohol use, history of peptic ulcer, history of major bleeding, abnormal liver function or renal function, cancer, platelet count <100 × 109 /L, anaemia, and concurrent antiplatelet agent or non-steroidal anti-inflammatory drug treatment were independent risk factors for GIB, and concurrent treatment with gastrointestinal protective agents were a protective factor. The Alfalfa-DOAC-GIB score was constructed using these 12 factors. The AUC of the Alfalfa-DOAC-GIB score was 0.77 (95% CI 0.74-0.81), which was higher than that of the HAS-BLED score (0.69; 95% CI 0.65-0.72) and the New score (0.65; 95% CI 0.61-0.68). CONCLUSIONS: Based on 12 factors, we developed a gastrointestinal bleeding risk score. The newly developed Alfalfa-DOAC-GIB score has better predictive value than the HAS-BLED score and the New score, and might be an effective tool to help reduce the occurrence of GIB in patients using DOACs.

Magnetically encoded 3D mesostructure with high-order shape morphing and high-frequency actuation.

Inspired by origami/kirigami, three-dimensional (3D) mesostructures assembled via a mechanics-guided approach, with reversible and maneuverable shape-morphing capabilities, have attracted great interest with regard to a broad range of applications. Despite intensive studies, the development of morphable 3D mesostructures with high-order (multi-degree-of-freedom) deformation and untethered high-frequency actuation remains challenging. This work introduces a scheme for a magnetically encoded transferable 3D mesostructure, with polyethylene terephthalate (PET) film as the skeleton and discrete magnetic domains as actuation units, to address this challenge. The high-order deformation, including hierarchical, multidirectional and blending shape morphing, is realized by encoding 3D discrete magnetization profiles on the architecture through ultraviolet curing. Reconfigurable 3D mesostructures with a modest structural modulus (∼3 GPa) enable both high-frequency (∼55 Hz) and large-deformation (∼66.8%) actuation under an alternating magnetic field. Additionally, combined with the shape-retention and adhesion property of PET, these 3D mesostructures can be readily transferred and attached to many solid substrates. On this basis, diverse functional devices, including a switchable colour letter display, liquid mixer, sequential flashlight and biomimetic sliding robot, are demonstrated to offer new perspectives for robotics and microelectronics.

Direct oral anticoagulants for venous thromboembolism in cancer patients: a systematic review and network meta-analysis.

BACKGROUND: The efficacy and safety of direct oral anticoagulants (DOACs), including dabigatran, apixaban, rivaroxaban, and edoxaban, for preventing and treating venous thromboembolism (VTE) in patients with cancer is unclear. METHODS: We searched the PubMed, Embase, Web of Science, and Cochrane Library databases from the establishment to November 30, 2021. In the frequency-based network meta-analysis, the odds ratio with a 95% confidence interval was reported. The relative ranking probability of each group was generated based on the surface under the cumulative ranking curve (SUCRA). RESULTS: We included 15 randomized controlled trials involving a total of 6162 patients. Apixaban reduced the risk of VTE compared with low-molecular heparin [OR = 0.53, 95% CI (0.32, 0.89)]. The efficacy of drugs was ranked from highest to lowest as follows: apixaban (SUCRA, 81.0), rivaroxaban (73.0), edoxaban (65.9), dabigatran (51.4), warfarin (30.8), and low-molecular-weight heparin (LMWH) (27.4). Edoxaban increased the risk of major bleeding compared with LMWH [OR = 1.83, 95% CI (1.04, 3.22)]. The safety of drugs was ranked from highest to lowest as follows: major bleeding-apixaban (SUCRA, 68.5), LMWH (55.1), rivaroxaban (53.0), warfarin (35.9), dabigatran (29.2), edoxaban (16.5) and clinically relevant non-major bleeding-LMWH (73.0), apixaban (57.8), edoxaban (45.8), rivaroxaban (35.3), and warfarin (10.8). CONCLUSIONS: For preventing and treating VTE, in terms of VTE occurrence and major bleeding, apixaban had the lowest risk; in terms of clinically relevant non-major bleeding, LMWH had the lowest risk, followed by apixaban. Generally, apixaban is the most efficient and safest DOAC and presents better efficacy and relatively low bleeding risk among the VTE prevention and treatment drugs for patients with cancer.