PMID- 18574082
OWN - NLM
STAT- MEDLINE
DCOM- 20080708
LR  - 20220419
IS  - 1538-3679 (Electronic)
IS  - 0003-9926 (Linking)
VI  - 168
IP  - 12
DP  - 2008 Jun 23
TI  - Low-molecular-weight heparin vs unfractionated heparin for perioperative 
      thromboprophylaxis in patients with cancer: a systematic review and 
      meta-analysis.
PG  - 1261-9
LID - 10.1001/archinte.168.12.1261 [doi]
AB  - BACKGROUND: The relative benefits and harms of low-molecular-weight heparin 
      (LMWH) and unfractionated heparin (UFH) are required for judgments regarding the 
      appropriate perioperative thromboprophylaxis in patients with cancer. We 
      systematically reviewed the literature to quantify these effects. METHODS: The 
      comprehensive searches included (1) an electronic search of MEDLINE, EMBASE, ISI 
      the Web of Science, and CENTRAL (The Cochrane Central Register of Controlled 
      Trials); (2) a hand search of relevant conference proceedings; (3) a reference 
      check of included trials; and (4) use of the PubMed "Related Articles" feature. 
      Outcomes of interest included mortality, deep venous thrombosis, pulmonary 
      embolism, bleeding complications, and thrombocytopenia. RESULTS: Of 3986 
      identified citations, we included 14 randomized clinical trials in the 
      meta-analysis (all using preoperative prophylactic anticoagulation). The overall 
      methodological quality was moderate. The meta-analysis showed no differences in 
      mortality in patients receiving LMWH compared with UFH (relative risk [RR], 0.89; 
      95% confidence interval [CI], 0.61-1.28) or in clinically suspected deep venous 
      thrombosis (RR, 0.73; 95% CI, 0.23-2.28). In a post hoc analysis including all 
      studies assessing deep venous thrombosis, irrespective of the diagnostic strategy 
      used, LMWH was superior to UFH (RR, 0.72; 95% CI, 0.55-0.94). There were no 
      differences in rates of pulmonary embolism (RR, 0.60; 95% CI, 0.22-1.64), minor 
      bleeding (RR, 0.88; 95% CI, 0.47-1.66), or major bleeding (RR, 0.95; 95% CI, 
      0.51-1.77). CONCLUSIONS: We found no differences in mortality in patients with 
      cancer receiving perioperative thromboprophylaxis with LMWH vs UFH. Further 
      trials are needed to more carefully evaluate the benefits and harms of different 
      heparin thromboprophylaxis strategies in this population.
FAU - Akl, Elie A
AU  - Akl EA
AD  - Department of Medicine, State University of New York at Buffalo, Erie County 
      Medical Center CC-142, 462 Grider St, Buffalo, NY 14215, USA. elieakl@buffalo.edu
FAU - Terrenato, Irene
AU  - Terrenato I
FAU - Barba, Maddalena
AU  - Barba M
FAU - Sperati, Francesca
AU  - Sperati F
FAU - Sempos, Elena V
AU  - Sempos EV
FAU - Muti, Paola
AU  - Muti P
FAU - Cook, Deborah J
AU  - Cook DJ
FAU - Schunemann, Holger J
AU  - Schunemann HJ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - Arch Intern Med
JT  - Archives of internal medicine
JID - 0372440
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
CIN - ACP J Club. 2008 Dec 16;149(6):11. PMID: 19071877
MH  - Anticoagulants/*therapeutic use
MH  - Heparin
MH  - Heparin, Low-Molecular-Weight
MH  - Humans
MH  - Neoplasms/*complications
MH  - Perioperative Care
MH  - Thrombosis/etiology/*prevention & control
RF  - 47
EDAT- 2008/06/25 09:00
MHDA- 2008/07/09 09:00
CRDT- 2008/06/25 09:00
PHST- 2008/06/25 09:00 [pubmed]
PHST- 2008/07/09 09:00 [medline]
PHST- 2008/06/25 09:00 [entrez]
AID - 168/12/1261 [pii]
AID - 10.1001/archinte.168.12.1261 [doi]
PST - ppublish
SO  - Arch Intern Med. 2008 Jun 23;168(12):1261-9. doi: 10.1001/archinte.168.12.1261.