PMID- 18720360
OWN - NLM
STAT- MEDLINE
DCOM- 20081021
LR  - 20191210
IS  - 0008-543X (Print)
IS  - 0008-543X (Linking)
VI  - 113
IP  - 7
DP  - 2008 Oct 1
TI  - Anticoagulation for the initial treatment of venous thromboembolism in patients 
      with cancer: a systematic review.
PG  - 1685-94
LID - 10.1002/cncr.23814 [doi]
AB  - BACKGROUND: The authors compared the relative efficacy and safety of 
      low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) for the 
      initial treatment of venous thromboembolism (VTE) between patients with and 
      without cancer. METHODS: By using Cochrane methodology for systematic reviews, 
      separate meta-analyses were conducted for subgroups of patients with and without 
      cancer, and relative risks (RRs) were compared for statistical significance. The 
      methodologic quality for each outcome was assessed by using the Grading of 
      Recommendations Assessment, Development, and Evaluation approach. RESULTS: LMWH 
      reduced mortality significantly compared with UFH in patients with cancer (RR of 
      0.71; 95% confidence interval [95% CI], 0.52-0.98 [moderate-quality evidence]) 
      but not in patients without cancer (RR of 0.97; 95% CI, 0.65-1.46 [low-quality 
      evidence]). However, the difference in the RR for the 2 subgroups did not reach 
      statistical significance (P = .113). The difference between LMWH and UFH in the 
      effect on recurrent VTE was not statistically significant in the subgroup with 
      cancer (RR of 0.78; 95% CI, 0.29-2.08 [low-quality evidence]), in the subgroup 
      without cancer (RR of 0.94; 95% CI, 0.60-1.46 [low-quality evidence]), or between 
      the 2 subgroups (P = .367). No data were available for bleeding outcomes, 
      thrombocytopenia, or postphlebitic syndrome. CONCLUSIONS: The current results 
      indicated that LMWH most likely is superior to UFH in reducing mortality in the 
      initial treatment of VTE for patients with cancer. There is a need for more and 
      better designed trials to confirm these findings.
FAU - Akl, Elie A
AU  - Akl EA
AD  - Department of Medicine, State University of New York at Buffalo, Buffalo, New 
      York 14215, USA. elieakl@buffalo.edu
FAU - Rohilla, Sandeep
AU  - Rohilla S
FAU - Barba, Maddalena
AU  - Barba M
FAU - Sperati, Francesca
AU  - Sperati F
FAU - Terrenato, Irene
AU  - Terrenato I
FAU - Muti, Paola
AU  - Muti P
FAU - Bdair, Fadi
AU  - Bdair F
FAU - Schunemann, Holger J
AU  - Schunemann HJ
LA  - eng
PT  - Comparative Study
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - Cancer
JT  - Cancer
JID - 0374236
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Heparin/adverse effects/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/adverse effects/*therapeutic use
MH  - Humans
MH  - Neoplasms/*complications
MH  - Venous Thromboembolism/*drug therapy
RF  - 45
EDAT- 2008/08/23 09:00
MHDA- 2008/10/22 09:00
CRDT- 2008/08/23 09:00
PHST- 2008/08/23 09:00 [pubmed]
PHST- 2008/10/22 09:00 [medline]
PHST- 2008/08/23 09:00 [entrez]
AID - 10.1002/cncr.23814 [doi]
PST - ppublish
SO  - Cancer. 2008 Oct 1;113(7):1685-94. doi: 10.1002/cncr.23814.