PMID- 18575417
OWN - NLM
STAT- MEDLINE
DCOM- 20080730
LR  - 20170306
VI  - 118
IP  - 4
DP  - 2008 Apr
TI  - Anticoagulation in patients with cancer: an overview of reviews.
PG  - 183-93
AB  - INTRODUCTION: Relative benefits and harms of anticoagulants are required for 
      judgments regarding appropriate anticoagulation in patients with cancer. 
      OBJECTIVES: To review the benefits and harms of anticoagulants for prophylactic, 
      therapeutic, and survival improvement indications in patients with cancer. 
      PATIENTS AND METHODS: Overview of 6 systematic reviews of anticoagulation in 
      cancer following the Cochrane Collaboration and Grading of Recommendations 
      Assessment, Development and Evaluation methodology. RESULTS: Central venous 
      catheters thromboprophylaxis with heparin or warfarin does not significantly 
      reduce the incidence of symptomatic deep vein thrombosis (DVT) (relative risk 
      [RR] 0.43, 95% CI 0.18-1.06 and RR 0.62, 95% CI 0.30-1.27 respectively). For 
      perioperative thromboprophylaxis, low-molecular-weight heparin (LMWH) and 
      unfractionated heparin (UFH) have similar effects on mortality (RR 0.89, 95% CI 
      0.61-1.28) and morbidity outcomes. For the initial treatment of venous 
      thromboembolism (VTE), LMWH compared with UFH reduces mortality at 3 months (RR 
      0.71, 95% CI 0.52-0.98). For the long-term treatment of VTE, LMWH compared with 
      vitamin K antagonists reduces VTE recurrence (hazard ratio [HR] 0.47, 95% CI 
      0.32-0.71) but not mortality (HR 0.96, 95% CI 0.81-1.14). As interventions to 
      improve survival, warfarin suggests a survival benefit at 6 months in the 
      subgroup of small cell lung cancer (SCLC) (RR 0.69, 95% CI 0.50-0.96) while 
      heparin suggests a survival benefit in patients with cancer in general (HR 0.77, 
      95% CI 0.65-0.91) and in those with limited SCLC in particular (HR 0.56, 95% CI 
      0.38-0.83). CONCLUSIONS: In patients with cancer, current evidence does not 
      support routine use of thromboprophylaxis for central venous catheters or a 
      specific anticoagulant for perioperative thromboprophylaxis. Anticoagulants may 
      improve survival, but more data will be useful in deciding which subgroups 
      benefit most.
FAU - Akl, Elie A
AU  - Akl EA
AD  - Department of Medicine, State University of New York at Buffalo, NY 14215, USA. 
      elieakl@buffalo.edu
FAU - Muti, Paola
AU  - Muti P
FAU - Schunemann, Holger J
AU  - Schunemann HJ
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Poland
TA  - Pol Arch Med Wewn
JT  - Polskie Archiwum Medycyny Wewnetrznej
JID - 0401225
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Anticoagulants/*therapeutic use
MH  - Catheterization, Central Venous/*adverse effects
MH  - Humans
MH  - *Neoplasms
MH  - Perioperative Care
MH  - Treatment Outcome
MH  - Venous Thrombosis/*drug therapy/etiology/*prevention & control
RF  - 39
EDAT- 2008/06/26 09:00
MHDA- 2008/07/31 09:00
CRDT- 2008/06/26 09:00
PHST- 2008/06/26 09:00 [pubmed]
PHST- 2008/07/31 09:00 [medline]
PHST- 2008/06/26 09:00 [entrez]
PST - ppublish
SO  - Pol Arch Med Wewn. 2008 Apr;118(4):183-93.