PMID- 18254108
OWN - NLM
STAT- MEDLINE
DCOM- 20080414
LR  - 20181221
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 1
DP  - 2008 Jan 23
TI  - Anticoagulation for the initial treatment of venous thromboembolism in patients 
      with cancer.
PG  - CD006649
LID - 10.1002/14651858.CD006649.pub2 [doi]
AB  - BACKGROUND: Compared to patients without cancer, patients with cancer receiving 
      anticoagulant treatment for venous thromboembolism are more likely to develop 
      recurrent venous thromboembolism (VTE). OBJECTIVES: To compare the efficacy and 
      safety of three types of anticoagulants (i.e. low molecular weight heparin 
      (LMWH), unfractionated heparin (UFH), and fondaparinux) for the initial treatment 
      of VTE in patients with cancer. SEARCH STRATEGY: A comprehensive search for 
      studies of anticoagulation in cancer patients including a January 2007 electronic 
      search of : Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, 
      EMBASE and ISI the Web of Science. SELECTION CRITERIA: Randomized clinical trials 
      (RCTs) comparing LMWH, UFH, and fondaparinux in patients with cancer and 
      objectively confirmed VTE. DATA COLLECTION AND ANALYSIS: Using a standardized 
      data form data was extracted in duplicate on methodological quality, 
      participants, interventions and outcomes of interest that included all cause 
      mortality, recurrent VTE, major bleeding, minor bleeding, thrombocytopenia and 
      postphlebitic syndrome. MAIN RESULTS: Of 3986 identified citations, 26 RCTs 
      including cancer patients as subgroups fulfilled the inclusion criteria. Cancer 
      subgroup data was obtained for 15 of the 26 RCTs. Thirteen studies compared a 
      LMWH to UFH while one study compared fondaparinux to UFH and one study compared 
      dalteparin to tinzaparin. Meta-analysis of 11 studies showed a statistically 
      significant mortality reduction in patients treated with LMWH compared with those 
      treated with UFH (Relative risk (RR) = 0.71; 95% confidence interval (CI) 0.52 to 
      0.98). There was little change in the results after excluding studies of lower 
      methodological quality (RR = 0.72; 95% CI 0.52 to 1.00). A meta-analysis of three 
      studies comparing LMWH with UFH in reducing recurrent VTE was inconclusive (RR = 
      0.78; 95% CI 0.29 to 2.08). No data was available for bleeding outcomes, 
      thrombocytopenia or postphlebitic syndrome. Compared to UFH, fondaparinux showed 
      a non-statistically significant benefit for the outcome of death (RR = 0.52; 95% 
      CI 0.26 to 1.05). The one study comparing dalteparin to tinzaparin showed a 
      non-statistically significant mortality reduction with dalteparin (RR = 0.86; 95% 
      CI 0.43 to 1.73). AUTHORS' CONCLUSIONS: Based on the included trials, LMWH is 
      likely to be superior to UFH in the initial treatment of VTE in patients with 
      cancer. However, there is a need for more trials to better address this research 
      question in cancer patients. Moreover, researchers should consider making the raw 
      data of RCTs available for individual patient data meta-analyses.
FAU - Akl, E A
AU  - Akl EA
AD  - State University of New York at Buffalo, Department of Medicine, ECMC, CC-142, 
      462 Girder Street, Buffalo, New York 14215, USA. elieakl@buffalo.edu
FAU - Rohilla, S
AU  - Rohilla S
FAU - Barba, M
AU  - Barba M
FAU - Sperati, F
AU  - Sperati F
FAU - Terrenato, I
AU  - Terrenato I
FAU - Muti, P
AU  - Muti P
FAU - Schunemann, H J
AU  - Schunemann HJ
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20080123
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  - 0 (Polysaccharides)
RN  - 9005-49-6 (Heparin)
RN  - J177FOW5JL (Fondaparinux)
SB  - IM
UIN - Cochrane Database Syst Rev. 2011;(2):CD006649. PMID: 21328285
MH  - Anticoagulants/*therapeutic use
MH  - Fondaparinux
MH  - Heparin/therapeutic use
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - Neoplasms/*complications
MH  - Polysaccharides/therapeutic use
MH  - Randomized Controlled Trials as Topic
MH  - Venous Thromboembolism/*drug therapy/mortality
RF  - 77
EDAT- 2008/02/07 09:00
MHDA- 2008/04/15 09:00
CRDT- 2008/02/07 09:00
PHST- 2008/02/07 09:00 [pubmed]
PHST- 2008/04/15 09:00 [medline]
PHST- 2008/02/07 09:00 [entrez]
AID - 10.1002/14651858.CD006649.pub2 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2008 Jan 23;(1):CD006649. doi: 
      10.1002/14651858.CD006649.pub2.