PMID- 24945634
OWN - NLM
STAT- MEDLINE
DCOM- 20151002
LR  - 20220310
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 6
DP  - 2014 Jun 19
TI  - Anticoagulation for the initial treatment of venous thromboembolism in patients 
      with cancer.
PG  - CD006649
LID - 10.1002/14651858.CD006649.pub6 [doi]
AB  - BACKGROUND: Compared with patients without cancer, patients with cancer who 
      receive anticoagulant treatment for venous thromboembolism (VTE) are more likely 
      to develop recurrent VTE. OBJECTIVES: To compare the efficacy and safety of three 
      types of parenteral anticoagulants (i.e. fixed-dose low molecular weight heparin 
      (LMWH), adjusted-dose unfractionated heparin (UFH), and fondaparinux) for the 
      initial treatment of VTE in patients with cancer. SEARCH METHODS: A comprehensive 
      search for studies of anticoagulation in patients with cancer including a 
      February 2013 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 LMWH, UFH, and fondaparinux in 
      patients with cancer and objectively confirmed VTE. DATA COLLECTION AND ANALYSIS: 
      Using a standardized data form, review authors extracted data in duplicate on 
      methodologic 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 9559 identified 
      citations, 16 RCTs were eligible: 13 compared LMWH with UFH, two compared 
      fondaparinux with heparin, and one compared dalteparin with tinzaparin. 
      Meta-analysis of 11 studies showed a statistically significant reduction in 
      mortality at three months of follow-up with LMWH compared with UFH (risk ratio 
      (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 methodologic 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 
      mortality (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 with tinzaparin found no 
      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 Internal Medicine, American University of Beirut, Riad El Solh St, 
      Beirut, Lebanon.
FAU - Kahale, Lara
AU  - Kahale L
FAU - Neumann, Ignacio
AU  - Neumann I
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  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20140619
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  - 7UQ7X4Y489 (Tinzaparin)
RN  - 9005-49-6 (Heparin)
RN  - J177FOW5JL (Fondaparinux)
RN  - S79O08V79F (Dalteparin)
SB  - IM
UOF - Cochrane Database Syst Rev. 2011;(6):CD006649. PMID: 21678360
UIN - Cochrane Database Syst Rev. 2018 Jan 24;1:CD006649. PMID: 29363105
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  - Tinzaparin
MH  - Venous Thromboembolism/*drug therapy/mortality
EDAT- 2014/06/20 06:00
MHDA- 2015/10/03 06:00
CRDT- 2014/06/20 06:00
PHST- 2014/06/20 06:00 [entrez]
PHST- 2014/06/20 06:00 [pubmed]
PHST- 2015/10/03 06:00 [medline]
AID - 10.1002/14651858.CD006649.pub6 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2014 Jun 19;(6):CD006649. doi: 
      10.1002/14651858.CD006649.pub6.