PMID- 22071865
OWN - NLM
STAT- MEDLINE
DCOM- 20120511
LR  - 20181221
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 11
DP  - 2011 Nov 9
TI  - Low molecular weight heparin versus unfractionated heparin for perioperative 
      thromboprophylaxis in patients with cancer.
PG  - CD009447
LID - 10.1002/14651858.CD009447 [doi]
AB  - BACKGROUND: The choice of the appropriate perioperative thromboprophylaxis in 
      patients with cancer depends on the relative benefits and harms of low molecular 
      weight heparin (LMWH) and unfractionated heparin (UFH). OBJECTIVES: To 
      systematically review the evidence for the relative efficacy and safety of LMWH 
      and UFH for perioperative thromboprophylaxis in patients with cancer. SEARCH 
      METHODS: A comprehensive search for trials 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 controlled trials (RCTs) that enrolled cancer patients 
      undergoing a surgical intervention and compared the effects of LMWH to UFH on 
      mortality, deep venous thrombosis (DVT), pulmonary embolism (PE), bleeding 
      outcomes, and thrombocytopenia. DATA COLLECTION AND ANALYSIS: Two review authors 
      used a standardized form to independently extract in duplicate data on risk of 
      bias, participants, interventions and outcomes of interest. Where possible, we 
      conducted meta-analyses using the random-effects model. MAIN RESULTS: Of 8187 
      identified citations, we included 16 RCTs with 11,847 patients in the 
      meta-analyses, all using preoperative prophylactic anticoagulation. The overall 
      quality of evidence was moderate. The meta-analysis did not conclusively rule out 
      either a beneficial or harmful effect of LMWH compared to UFH for the following 
      outcomes: mortality (RR = 0.90; 95% CI 0.73 to 1.10), symptomatic DVT (RR = 0.73; 
      95% CI 0.23 to 2.28), PE (RR = 0.59; 95% CI 0.25 to1.41), minor bleeding (RR = 
      0.88; 95% CI 0.47 to 1.66) and major bleeding (RR = 0.84; 95% CI 0.52 to 1.36). 
      LMWH was associated with lower incidence of wound hematoma (RR = 0.60; 95% CI 
      0.43, 0.84) while UFH was associated with higher incidence of intra-operative 
      transfusion (RR = 1.16; 95% CI 0.69,1.62). AUTHORS' CONCLUSIONS: We found no 
      difference between perioperative thromboprophylaxis with LMWH verus UFH in their 
      effects on mortality and embolic outcomes in patients with cancer. Further trials 
      are needed to more carefully evaluate the benefits and harms of different heparin 
      thromboprophylaxis strategies in this population.
FAU - Akl, Elie A
AU  - Akl EA
AD  - Department of Medicine, State University of New York at Buffalo, Buffalo, NY, 
      USA. elieakl@buffalo.edu.
FAU - Labedi, Nawman
AU  - Labedi N
FAU - Terrenato, Irene
AU  - Terrenato I
FAU - Barba, Maddalena
AU  - Barba M
FAU - Sperati, Francesca
AU  - Sperati F
FAU - Sempos, Elena V
AU  - Sempos EV
FAU - Muti, Paola
AU  - Muti P
FAU - Cook, Deborah
AU  - Cook D
FAU - Schunemann, Holger
AU  - Schunemann H
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20111109
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  - 9005-49-6 (Heparin)
SB  - IM
UIN - Cochrane Database Syst Rev. 2014;6:CD009447. PMID: 24966161
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Hemorrhage/chemically induced
MH  - Heparin/*administration & dosage/adverse effects
MH  - Heparin, Low-Molecular-Weight/*administration & dosage/adverse effects
MH  - Humans
MH  - Neoplasms/mortality/*surgery
MH  - Postoperative Complications/mortality/*prevention & control
MH  - Pulmonary Embolism/prevention & control
MH  - Thrombocytopenia/prevention & control
MH  - Thrombosis/mortality/*prevention & control
MH  - Venous Thrombosis/prevention & control
EDAT- 2011/11/11 06:00
MHDA- 2012/05/12 06:00
CRDT- 2011/11/11 06:00
PHST- 2011/11/11 06:00 [entrez]
PHST- 2011/11/11 06:00 [pubmed]
PHST- 2012/05/12 06:00 [medline]
AID - 10.1002/14651858.CD009447 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2011 Nov 9;(11):CD009447. doi: 
      10.1002/14651858.CD009447.