PMID- 22336844
OWN - NLM
STAT- MEDLINE
DCOM- 20120523
LR  - 20220129
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 2
DP  - 2012 Feb 15
TI  - Primary prophylaxis for venous thromboembolism in ambulatory cancer patients 
      receiving chemotherapy.
PG  - CD008500
LID - 10.1002/14651858.CD008500.pub2 [doi]
AB  - BACKGROUND: Venous thromboembolism (VTE) often complicates the clinical course of 
      cancer disease. The risk is further increased by chemotherapy but the safety and 
      efficacy of primary thromboprophylaxis in cancer patients treated with 
      chemotherapy is uncertain. OBJECTIVES: To assess the efficacy and safety of 
      primary thromboprophylaxis in ambulatory cancer patients receiving chemotherapy. 
      SEARCH METHODS: The Cochrane Peripheral Vascular Diseases Group searched their 
      Specialised Register (last searched 3 May 2011) and CENTRAL (2011, Issue 2). The 
      authors searched clinical trials registries and reference lists of relevant 
      studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing 
      unfractionated heparin (UFH), low molecular weight heparin (LMWH), vitamin K 
      antagonists (VKA), direct thrombin inhibitors, direct factor Xa inhibitors or 
      mechanical intervention to no intervention or placebo; or comparing two different 
      anticoagulants. DATA COLLECTION AND ANALYSIS: Data were extracted on 
      methodological quality, patients, interventions and outcomes including 
      symptomatic VTE and major bleeding as the primary effectiveness and safety 
      outcomes, respectively. MAIN RESULTS: Nine RCTs with a total of 3538 patients 
      were considered. None of the RCTs tested UFH, fondaparinux, direct factor Xa 
      inhibitors or mechanical interventions. Overall, the risk of bias was low in most 
      of the studies. LMWH, when compared with inactive control, significantly reduced 
      the incidence of symptomatic VTE (risk ratio (RR) 0.62, 95% confidence interval 
      (CI) 0.41 to 0.93) with no evidence of heterogeneity (I(2) = 0%). The number 
      needed to treat to prevent a symptomatic VTE was 60. LMWH was associated with a 
      60% increase in major bleeding when compared with inactive control, although this 
      was not statistically significant (RR 1.57, 95% CI 0.69 to 3.60; I(2) = 10%). 
      There was a 45% reduction in overall VTE (RR 0.55, 95% CI 0.34 to 0.88; I(2) = 
      0%) while for symptomatic pulmonary embolism, asymptomatic VTE, minor bleeding 
      and one-year mortality the differences between the LMWH and control groups were 
      not statistically significant. The effect of the vitamin K antagonist warfarin on 
      preventing symptomatic VTE, measured in only one study, was not statistically 
      significant (RR 0.15, 95% CI 0.02 to 1.20). In one RCT of patients with myeloma, 
      LMWH was associated with a 67% reduction in symptomatic VTE (RR 0.33, 95% CI 0.14 
      to 0.83) compared with warfarin, with no differences in major bleeding. 
      Antithrombin, evaluated in one study on paediatric patients, had no significant 
      effect on VTE nor major bleeding when compared with inactive control. AUTHORS' 
      CONCLUSIONS: Primary thromboprophylaxis with LMWH significantly reduced the 
      incidence of symptomatic VTE in ambulatory cancer patients treated with 
      chemotherapy. However, the lack of power hampers definite conclusions on the 
      effects on major safety outcomes, which mandates additional studies to determine 
      the risk to benefit ratio of LMWH in this setting.
FAU - Di Nisio, Marcello
AU  - Di Nisio M
AD  - Department of Medicine and Aging; Centre for Aging Sciences (Ce.S.I.), Internal 
      Medicine Unit, "University G. D'Annunzio"Foundation, Chieti, Italy. 
      mdinisio@unich.it.
FAU - Porreca, Ettore
AU  - Porreca E
FAU - Ferrante, Noemi
AU  - Ferrante N
FAU - Otten, Hans-Martin
AU  - Otten HM
FAU - Cuccurullo, Franco
AU  - Cuccurullo F
FAU - Rutjes, Anne W S
AU  - Rutjes AW
LA  - eng
GR  - CZB/4/788/CSO_/Chief Scientist Office/United Kingdom
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20120215
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Anticoagulants)
RN  - 0 (Antineoplastic Agents)
RN  - 0 (Antithrombins)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - 9005-49-6 (Heparin)
SB  - IM
UIN - Cochrane Database Syst Rev. 2014;(8):CD008500. PMID: 25171736
MH  - Adult
MH  - *Ambulatory Care
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Antineoplastic Agents/adverse effects
MH  - Antithrombins/therapeutic use
MH  - Child
MH  - Heparin/adverse effects/therapeutic use
MH  - Heparin, Low-Molecular-Weight/adverse effects/therapeutic use
MH  - Humans
MH  - Neoplasms/complications/*drug therapy
MH  - Pulmonary Embolism/etiology/prevention & control
MH  - Randomized Controlled Trials as Topic
MH  - Venous Thromboembolism/etiology/*prevention & control
MH  - Warfarin/adverse effects/therapeutic use
EDAT- 2012/02/18 06:00
MHDA- 2012/05/24 06:00
CRDT- 2012/02/17 06:00
PHST- 2012/02/17 06:00 [entrez]
PHST- 2012/02/18 06:00 [pubmed]
PHST- 2012/05/24 06:00 [medline]
AID - 10.1002/14651858.CD008500.pub2 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2012 Feb 15;(2):CD008500. doi: 
      10.1002/14651858.CD008500.pub2.