PMID- 21678360
OWN - NLM
STAT- MEDLINE
DCOM- 20110824
LR  - 20200511
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 6
DP  - 2011 Jun 15
TI  - Anticoagulation for the initial treatment of venous thromboembolism in patients 
      with cancer.
PG  - CD006649
LID - 10.1002/14651858.CD006649.pub5 [doi]
AB  - BACKGROUND: Compared to patients without cancer, patients with cancer who receive 
      anticoagulant treatment for venous thromboembolism are more likely to develop 
      recurrent venous thromboembolism (VTE). OBJECTIVES: To compare the efficacy and 
      safety of three types of parenteral anticoagulants for the initial treatment of 
      VTE in patients with cancer. SEARCH STRATEGY: A comprehensive search for studies 
      of anticoagulation in cancer patients including a February 2010 electronic search 
      of: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE 
      and ISI Web of Science. SELECTION CRITERIA: Randomized clinical trials (RCTs) 
      comparing low molecular weight heparin (LMWH), unfractionated heparin (UFH), and 
      fondaparinux in patients with cancer and objectively confirmed VTE. DATA 
      COLLECTION AND ANALYSIS: Using a standardized data form, data was extracted in 
      duplicate on methodological quality, participants, interventions, and outcomes of 
      interest that included mortality, recurrent VTE, major bleeding, minor bleeding, 
      postphlebitic syndrome, quality of life, and thrombocytopenia. MAIN RESULTS: Of 
      3986 identified citations, 16 RCTs were eligible: 13 compared LMWH to UFH, two 
      compared fondaparinux to heparin, and one compared dalteparin to tinzaparin. 
      Meta-analysis of 11 studies showed a statistically significant reduction in 
      mortality at three months of follow up with LMWH compared with UFH (relative risk 
      (RR) 0.71; 95% confidence interval (CI) 0.52 to 0.98). There was little change in 
      the effect estimate after excluding studies of lower methodological quality (RR 
      0.72; 95% CI 0.52 to 1.00). A meta-analysis of three studies comparing LMWH with 
      UFH showed no statistically significant reduction in VTE recurrence (RR 0.78; 95% 
      CI 0.29 to 2.08). The overall quality of evidence was low for LMWH versus UFH due 
      to imprecision and likely publication bias. There were no statistically 
      significant differences between heparin and fondaparinux for the outcomes of 
      death (RR 1.27; 95% CI 0.88 to 1.84), recurrent VTE (RR 0.95; 95% CI 0.57 to 
      1.60), major bleeding (RR 0.79; 95% CI 0.39 to1.63) or minor bleeding (RR 1.50; 
      95% CI 0.87 to 2.59). The one study comparing dalteparin to tinzaparin did not 
      find a statistically significant difference in mortality (RR 0.86; 95% CI 0.43 to 
      1.73). AUTHORS' CONCLUSIONS: LMWH is possibly superior to UFH in the initial 
      treatment of VTE in patients with cancer. Additional trials focusing on patient 
      important outcomes will further inform the questions addressed in this review.
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 - Barba, Maddalena
AU  - Barba M
FAU - Sperati, Francesca
AU  - Sperati F
FAU - Terrenato, Irene
AU  - Terrenato I
FAU - Muti, Paola
AU  - Muti P
FAU - Schunemann, Holger
AU  - Schunemann H
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20110615
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Polysaccharides)
RN  - 9005-49-6 (Heparin)
RN  - J177FOW5JL (Fondaparinux)
RN  - S79O08V79F (Dalteparin)
SB  - IM
UOF - Cochrane Database Syst Rev. 2011;(4):CD006649. PMID: 21491395
UIN - Cochrane Database Syst Rev. 2014;6:CD006649. PMID: 24945634
MH  - Anticoagulants/*therapeutic use
MH  - Dalteparin/therapeutic use
MH  - Fibrinolytic Agents/therapeutic use
MH  - Fondaparinux
MH  - Heparin/therapeutic use
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - Neoplasms/*complications
MH  - Polysaccharides/therapeutic use
MH  - Randomized Controlled Trials as Topic
MH  - Secondary Prevention
MH  - Venous Thromboembolism/*drug therapy/mortality
EDAT- 2011/06/17 06:00
MHDA- 2011/08/25 06:00
CRDT- 2011/06/17 06:00
PHST- 2011/06/17 06:00 [entrez]
PHST- 2011/06/17 06:00 [pubmed]
PHST- 2011/08/25 06:00 [medline]
AID - 10.1002/14651858.CD006649.pub5 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2011 Jun 15;(6):CD006649. doi: 
      10.1002/14651858.CD006649.pub5.