PMID- 17636846
OWN - NLM
STAT- MEDLINE
DCOM- 20071018
LR  - 20181221
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 3
DP  - 2007 Jul 18
TI  - Parenteral anticoagulation for prolonging survival in patients with cancer who 
      have no other indication for anticoagulation.
PG  - CD006652
AB  - BACKGROUND: Basic research and clinical studies have generated the hypothesis 
      that anticoagulation may improve survival in patients with cancer through an 
      antitumour effect in addition to the antithrombotic effect. OBJECTIVES: To 
      evaluate the efficacy and safety of heparin (including unfractionated heparin 
      (UFH) and low molecular weight heparin (LMWH)) and fondaparinux to improve 
      survival of patients with cancer. SEARCH STRATEGY: A comprehensive search for 
      studies of anticoagulation in cancer patients including (1) A January 2007 
      electronic search of the following databases: Cochrane Central Register of 
      Controlled Trials (CENTRAL), MEDLINE, EMBASE and ISI the Web of Science; (2) Hand 
      search of the American Society of Clinical Oncology and of the American Society 
      of Hematology; (3) Checking of references of included studies; and (4) Use of 
      "related article" feature in PubMed. SELECTION CRITERIA: We included randomized 
      controlled trials (RCTs) in cancer patients without clinical evidence of venous 
      thromboembolism comparing UFH, LMWH or fondaparinux to no intervention or placebo 
      and RCTs comparing two of the three agents of interest. DATA COLLECTION AND 
      ANALYSIS: Using a standardized form we extracted in duplicate data on 
      methodological quality, participants, interventions and outcomes of interest 
      including all cause mortality, venous thrombosis, symptomatic pulmonary embolism, 
      major bleeding and minor bleeding. MAIN RESULTS: Of 3986 identified citations 
      five RCTs fulfilled the inclusion criteria. In all included RCTs the intervention 
      consisted of heparin ( either UFH or LMWH). The overall methodological quality of 
      the included studies was acceptable. Overall, heparin therapy was associated with 
      a statistically and clinically significant survival benefit (hazard ratio (HR) = 
      0.77; 95% CI: 0.65 to 0.91). In subgroup analyses, patients with limited small 
      cell lung cancer experienced a clear survival benefit (HR = 0.56; 95% CI: 0.38 to 
      0.83). The survival benefit was not statistically significant for either patients 
      with extensive small cell lung cancer (HR = 0.80; 95% CI: 0.60 to 1.06) or 
      patients with advanced cancer (HR = 0.84; 95%: 0.68 to 1.03). The increased risk 
      of bleeding with heparin was not statistically significant (RR = 1.78; 95% CI: 
      0.73 to 4.38). AUTHORS' CONCLUSIONS: Heparin has a survival benefit in cancer 
      patients in general, and in patients with limited small cell lung cancer in 
      particular. Heparin might be particularly beneficial in cancer patients with 
      limited cancer or a longer life expectancy. Future research should investigate 
      the survival benefit of different types of anticoagulants (in different dosing, 
      schedules and duration of therapy) in patients with different types and stages of 
      cancers.
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 - van Doormaal, F F
AU  - van Doormaal FF
FAU - Barba, M
AU  - Barba M
FAU - Kamath, G
AU  - Kamath G
FAU - Kim, S Y
AU  - Kim SY
FAU - Kuipers, S
AU  - Kuipers S
FAU - Middeldorp, S
AU  - Middeldorp S
FAU - Yosuico, V
AU  - Yosuico V
FAU - Dickinson, H O
AU  - Dickinson HO
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  - 5Q7ZVV76EI (Warfarin)
RN  - 9005-49-6 (Heparin)
SB  - IM
UIN - Cochrane Database Syst Rev. 2011;(1):CD006652. PMID: 21249680
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Carcinoma, Small Cell/mortality
MH  - Hemorrhage/chemically induced
MH  - Heparin/*administration & dosage/adverse effects
MH  - Heparin, Low-Molecular-Weight/administration & dosage
MH  - Humans
MH  - Lung Neoplasms/mortality
MH  - Neoplasms/*mortality
MH  - Randomized Controlled Trials as Topic
MH  - Survival Analysis
MH  - Warfarin/administration & dosage
RF  - 69
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.CD006652 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2007 Jul 18;(3):CD006652. doi: 
      10.1002/14651858.CD006652.