PMID- 18577254
OWN - NLM
STAT- MEDLINE
DCOM- 20081031
LR  - 20231103
IS  - 1756-9966 (Electronic)
IS  - 0392-9078 (Print)
IS  - 0392-9078 (Linking)
VI  - 27
IP  - 1
DP  - 2008 May 15
TI  - Parenteral anticoagulation may prolong the survival of patients with limited 
      small cell lung cancer: a Cochrane systematic review.
PG  - 4
LID - 10.1186/1756-9966-27-4 [doi]
AB  - BACKGROUND: To determine the efficacy and safety of heparin (unfractionated 
      heparin (UFH) or low-molecular-weight-heparin (LMWH)) and fondaparinux in 
      improving the survival of patients with cancer. METHODS: We conducted in January 
      2007 a comprehensive search for relevant randomized clinical trials (RCTs). We 
      used a standardized form to extract in duplicate data on methodological quality, 
      participants, interventions and outcomes of interest including all cause 
      mortality, thromboembolic events, and bleeding events. We assessed the 
      methodological quality for each outcome by grading the quality of evidence using 
      the Grading of Recommendations Assessment, Development and Evaluation (GRADE) 
      methodology RESULTS: Of 3986 identified citations, we included 5 RCTs, none of 
      which evaluated fondaparinux. The quality of evidence was moderate for survival, 
      low for major and minor bleeding, and very low for DVT. Heparin therapy was 
      associated with a statistically and clinically significant survival benefit 
      (hazard ratio (HR) = 0.77; 95%CI = 0.65-0.91). In subgroup analyses, patients 
      with limited small cell lung cancer experienced a clear survival benefit (HR = 
      0.56; 95%CI = 0.38-0.83). The survival benefit was not statistically significant 
      for either patients with extensive small cell lung cancer (HR = 0.80; 95%CI = 
      0.60-1.06) or patients with advanced cancer (HR = 0.84; 95%CI = 0.68-1.03). The 
      increased risk of bleeding with heparin was not statistically significant 
      (relative risk (RR) = 1.78; 95%CI = 0.73-4.38). CONCLUSION: This review suggests 
      a survival benefit of heparin in cancer patients in general, and in patients with 
      limited small cell lung cancer in particular.
FAU - Akl, Elie A
AU  - Akl EA
AD  - Department of Medicine, State University of New York at Buffalo, NY, USA. 
      elieakl@buffalo.edu
FAU - van Doormaal, Frederiek F
AU  - van Doormaal FF
FAU - Barba, Maddalena
AU  - Barba M
FAU - Kamath, Ganesh
AU  - Kamath G
FAU - Kim, Seo Young
AU  - Kim SY
FAU - Kuipers, Saskia
AU  - Kuipers S
FAU - Middeldorp, Saskia
AU  - Middeldorp S
FAU - Yosuico, Victor
AU  - Yosuico V
FAU - Dickinson, Heather O
AU  - Dickinson HO
FAU - Schunemann, Holger J
AU  - Schunemann HJ
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20080515
PL  - England
TA  - J Exp Clin Cancer Res
JT  - Journal of experimental & clinical cancer research : CR
JID - 8308647
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Polysaccharides)
RN  - J177FOW5JL (Fondaparinux)
SB  - IM
MH  - Anticoagulants/administration & dosage/adverse effects/*therapeutic use
MH  - Carcinoma, Small Cell/*drug therapy/etiology/mortality
MH  - Fondaparinux
MH  - Heparin, Low-Molecular-Weight/administration & dosage/adverse effects/therapeutic 
      use
MH  - Humans
MH  - Lung Neoplasms/*drug therapy/etiology
MH  - Polysaccharides/administration & dosage/adverse effects/therapeutic use
MH  - Survival Analysis
MH  - Treatment Outcome
PMC - PMC2438335
EDAT- 2008/06/26 09:00
MHDA- 2008/11/01 09:00
PMCR- 2008/05/15
CRDT- 2008/06/26 09:00
PHST- 2008/04/29 00:00 [received]
PHST- 2008/05/15 00:00 [accepted]
PHST- 2008/06/26 09:00 [pubmed]
PHST- 2008/11/01 09:00 [medline]
PHST- 2008/06/26 09:00 [entrez]
PHST- 2008/05/15 00:00 [pmc-release]
AID - 1756-9966-27-4 [pii]
AID - 10.1186/1756-9966-27-4 [doi]
PST - epublish
SO  - J Exp Clin Cancer Res. 2008 May 15;27(1):4. doi: 10.1186/1756-9966-27-4.