PMID- 21328283
OWN - NLM
STAT- MEDLINE
DCOM- 20110323
LR  - 20200511
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 2
DP  - 2011 Feb 16
TI  - Anticoagulation for patients with cancer and central venous catheters.
PG  - CD006468
LID - 10.1002/14651858.CD006468.pub3 [doi]
AB  - BACKGROUND: Central venous catheter (CVC) placement increases the risk of 
      thrombosis in cancer patients. Thrombosis often necessitates the removal of the 
      CVC, resulting in treatment delays and thrombosis related morbidity and 
      mortality. OBJECTIVES: To evaluate the efficacy and safety of anticoagulation in 
      cancer patients with a CVC. SEARCH STRATEGY: We searched The Cochrane Central 
      Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1 2010), 
      MEDLINE (January 1966 to February 2010; accessed via OVID), EMBASE (January 1980 
      to February 2010; accessed via OVID) and ISI the Web of Science (1975 to February 
      2010). We handsearched conference proceedings, checked references of included 
      studies and used the "related article" feature within PubMed. SELECTION CRITERIA: 
      Randomized controlled trials (RCTs) comparing any dose of unfractionated heparin 
      (UFH), low molecular weight heparin (LMWH), vitamin K antagonists (VKA), or 
      fondaparinux to no intervention or placebo or comparing two different 
      anticoagulants in cancer patients with a CVC. DATA COLLECTION AND ANALYSIS: Two 
      authors independently extracted data from each included study and resolved their 
      disagreements by discussion. MAIN RESULTS: Of 8187 identified citations, we 
      included 12 RCTs enrolling 3611 patients and assessing either prophylactic dose 
      heparin or low dose VKAs. Prophylactic dose heparin was not associated with a 
      statistically significant effect on death (relative risk (RR) = 0.85; 95% 
      confidence interval (CI): 0.53 to 1.37), symptomatic deep venous thrombosis (DVT) 
      (RR = 0.54; 95% CI: 0.28 to 1.05) asymptomatic DVT (RR = 0.81; 95% CI: 0.64 to 
      1.02), major bleeding (RR = 0.68; 95% CI: 0.10 to 4.78), thrombocytopenia (RR = 
      0.85; 95% CI: 0.49 to 1.46), or infection (RR = 0.91; 95% CI: 0.49 to 1.68). 
      Similarly, low dose VKAs were not associated with a statistically significant 
      effect on death (RR = 0.97; 95% CI: 0.82 to 1.15), symptomatic DVT (RR = 0.63; 
      95% CI: 0.35 to 1.11) or major bleeding (RR = 6.93; 95% CI: 0.86 to 56.08). 
      However, they were associated with a statistically significant reduction in 
      asymptomatic DVT (RR = 0.42; 95% CI: 0.28 to 0.61). Studies comparing heparin to 
      VKA found no effects on any of the outcomes of interest. AUTHORS' CONCLUSIONS: We 
      found no statistically significant effect of heparin or VKA on the outcomes of 
      interest. However, the findings did not rule out clinically important benefits 
      and harms. Patients with cancer with CVCs considering anticoagulation should 
      balance the possible benefit of reduced thromboembolic complications with the 
      possible harms and burden of anticoagulants.
FAU - Akl, Elie A
AU  - Akl EA
AD  - Department of Medicine, State University of New York at Buffalo, ECMC CC-142, 462 
      Grider Street, Buffalo, NY, USA, 14215.
FAU - Vasireddi, Srinivasa Rao
AU  - Vasireddi SR
FAU - Gunukula, Sameer
AU  - Gunukula S
FAU - Yosuico, Victor E D
AU  - Yosuico VE
FAU - Barba, Maddalena
AU  - Barba M
FAU - Sperati, Francesca
AU  - Sperati F
FAU - Cook, Deborah
AU  - Cook D
FAU - Schunemann, Holger
AU  - Schunemann H
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20110216
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  - 12001-79-5 (Vitamin K)
RN  - 9005-49-6 (Heparin)
SB  - IM
UOF - Cochrane Database Syst Rev. 2007;(3):CD006468. PMID: 17636845
UIN - Cochrane Database Syst Rev. 2011;(4):CD006468. PMID: 21491394
MH  - Anticoagulants/*therapeutic use
MH  - Catheterization, Central Venous/*adverse effects
MH  - Heparin/therapeutic use
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - *Neoplasms/pathology
MH  - Randomized Controlled Trials as Topic
MH  - Venous Thrombosis/etiology/*prevention & control
MH  - Vitamin K/antagonists & inhibitors
EDAT- 2011/02/18 06:00
MHDA- 2011/03/24 06:00
CRDT- 2011/02/18 06:00
PHST- 2011/02/18 06:00 [entrez]
PHST- 2011/02/18 06:00 [pubmed]
PHST- 2011/03/24 06:00 [medline]
AID - 10.1002/14651858.CD006468.pub3 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2011 Feb 16;(2):CD006468. doi: 
      10.1002/14651858.CD006468.pub3.