PMID- 17636845
OWN - NLM
STAT- MEDLINE
DCOM- 20071018
LR  - 20181221
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 3
DP  - 2007 Jul 18
TI  - Anticoagulation for thrombosis prophylaxis in cancer patients with central venous 
      catheters.
PG  - CD006468
AB  - BACKGROUND: Central venous catheter (CVC) placement increases the risk of 
      thrombosis in cancer patients. Thrombosis often necessitates the removal of the 
      CVC, resulting in treatment delays and thrombosis related morbidity and 
      mortality. OBJECTIVES: To evaluate the efficacy and safety of anticoagulation in 
      reducing venous thromboembolic (VTE) events in cancer patients with CVC. SEARCH 
      STRATEGY: A comprehensive search for studies of anticoagulation in cancer 
      patients up to January 2006 was conducted in the following databases: The 
      Cochrane Central Register of Controlled Trials ( CENTRAL), MEDLINE, EMBASE and 
      ISI the Web of Science. SELECTION CRITERIA: Randomized controlled trials (RCTs) 
      comparing unfractionated heparin (UFH), low molecular weight heparin (LMWH), 
      vitamin K antagonists (VKA), fondaparinux or ximelagatran to no intervention or 
      placebo in cancer patients with a CVC or comparing two different anticoagulants. 
      DATA COLLECTION AND ANALYSIS: Data was extracted on methodological quality, 
      patients, interventions and outcomes including all cause mortality (primary 
      outcome), premature CVC removal, catheter-related infections, CVC site and non 
      CVC site deep venous thrombosis (DVT), pulmonary embolism (PE), major and minor 
      bleeding and thrombocytopenia. MAIN RESULTS: Of 3986 identified citations nine 
      RCTs were included in the meta-analysis including one published as an abstract 
      and one focusing on paediatric patients not included in the meta-analysis. None 
      of these RCTs tested fondaparinux or ximelagatran. The use of heparin in cancer 
      patients with CVC was associated with a trend towards a reduction in symptomatic 
      DVT (Relative Risk (RR) = 0.43; 95% Confidence Interval (CI): 0.18 to 1.06), but 
      the data did not show any statistically significant effect on mortality (RR = 
      0.74; 95% CI: 0.40 to 1.36), infection (RR = 0.91; 95% CI: 0.36 to 2.28), major 
      bleeding (RR = 0.68; 95% CI: 0.10 to 4.78) or thrombocytopenia (RR = 0.85; 95% 
      CI: 0.49 to 1.46). The effect warfarin on symptomatic DVT was not statistically 
      significant (RR = 0.62; 95% CI: 0.30 to 1.27). When studies assessing different 
      types of anticoagulants were pooled, symptomatic DVT rates were significantly 
      reduced (RR = 0.56; 95% CI: 0.34 to 0.92). AUTHORS' CONCLUSIONS: Cancer patients 
      with CVC considering anticoagulation, should consider the possible benefit of 
      reduced incidence of thromboembolic complications with the burden and harms of 
      anticoagulation. Future studies should be adequately powered and evaluate the 
      effects of newer anticoagulants such as fondaparinux and ximelagatran in cancer 
      patients with CVC.
FAU - Akl, E A
AU  - Akl EA
AD  - State University of New York at Buffalo, Medicine, ECMC, CC-142, 462 Girder 
      Street, Buffalo, New York 14215, USA. elieakl@buffalo.edu
FAU - Karmath, G
AU  - Karmath G
FAU - Yosuico, V
AU  - Yosuico V
FAU - Kim, S Y
AU  - Kim SY
FAU - Barba, M
AU  - Barba M
FAU - Sperati, F
AU  - Sperati F
FAU - Cook, D
AU  - Cook D
FAU - Schunemann, H J
AU  - Schunemann HJ
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20070718
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 12001-79-5 (Vitamin K)
RN  - 9005-49-6 (Heparin)
SB  - IM
UIN - Cochrane Database Syst Rev. 2011;(2):CD006468. PMID: 21328283
MH  - Anticoagulants/*therapeutic use
MH  - Catheterization, Central Venous/*adverse effects
MH  - Heparin/therapeutic use
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - *Neoplasms
MH  - Randomized Controlled Trials as Topic
MH  - Venous Thrombosis/etiology/*prevention & control
MH  - Vitamin K/antagonists & inhibitors
RF  - 60
EDAT- 2007/07/20 09:00
MHDA- 2007/10/19 09:00
CRDT- 2007/07/20 09:00
PHST- 2007/07/20 09:00 [pubmed]
PHST- 2007/10/19 09:00 [medline]
PHST- 2007/07/20 09:00 [entrez]
AID - 10.1002/14651858.CD006468.pub2 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2007 Jul 18;(3):CD006468. doi: 
      10.1002/14651858.CD006468.pub2.