PMID- 24966161
OWN - NLM
STAT- MEDLINE
DCOM- 20151002
LR  - 20181202
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 6
DP  - 2014 Jun 26
TI  - Low molecular weight heparin versus unfractionated heparin for perioperative 
      thromboprophylaxis in patients with cancer.
PG  - CD009447
LID - 10.1002/14651858.CD009447.pub2 [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 update a 
      systematic review of the evidence for the relative efficacy and safety of LMWH 
      and UFH for perioperative thromboprophylaxis in patients with cancer. SEARCH 
      METHODS: We performed a comprehensive search for trials of anticoagulation in 
      patients with cancer including a February 2013 electronic search of: the Cochrane 
      Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE. We also 
      handsearched conference proceedings, reviewed reference list of included studies, 
      used the 'related citations' feature in PubMed, and searched clinicaltrials.gov 
      for ongoing studies. SELECTION CRITERIA: Randomized controlled trials (RCTs) that 
      enrolled patients with cancer undergoing a surgical intervention and compared the 
      effects of LMWH to UFH on mortality, deep venous thrombosis (DVT), pulmonary 
      embolism (PE), bleeding outcomes, or thrombocytopenia. DATA COLLECTION AND 
      ANALYSIS: Two review authors independently used a standardized form to extract in 
      duplicate data on participants, interventions, outcomes of interest, and risk of 
      bias. Where possible, we conducted meta-analyses using the random-effects model. 
      MAIN RESULTS: Of 9559 identified unique citations, we included 16 RCTs with 
      12,890 patients with cancer, all using preoperative prophylactic anticoagulation. 
      We identified no new study with this update. The overall quality of evidence was 
      moderate. The meta-analyses did not conclusively rule out either a beneficial or 
      harmful effect of LMWH compared with UFH for the following outcomes: mortality 
      (risk ratio (RR) 0.89; 95% confidence interval (CI) 0.74 to 1.08), PE (RR 0.73; 
      95% CI 0.34 to 1.54), symptomatic DVT (RR 0.50; 95% CI 0.20 to 1.28), 
      asymptomatic DVT (RR 0.81; 95% CI 0.66 to 1.01),major bleeding (RR 0.85; 95% CI 
      0.52 to 1.37), and minor bleeding (RR 0.92; 95% CI 0.47 to 1.79). LMWH was 
      associated with lower incidence of wound hematoma (RR 0.68; 95% CI 0.52 to 0.88) 
      but higher volume of intraoperative transfusion (mean difference (MD) 74 mL; 95% 
      CI 47 to 102). The meta-analyses found no statistically significant differences 
      for any of the following outcomes: reoperation for bleeding (RR 0.72; 95% CI 0.06 
      to 8.48) , intraoperative blood loss (MD= -6mL; 95% CI -87 to 74), postoperative 
      transfusion (MD= 79mL; 95% CI -54 to 211), postoperative drain volume (MD= 27mL; 
      95% CI -44 to 98), and thrombocytopenia (RR 1.33; 95% CI 0.59 to 3.00). AUTHORS' 
      CONCLUSIONS: We found no difference between perioperative thromboprophylaxis with 
      LMWH versus UFH in their effects on mortality, thromboembolic outcomes, major 
      bleeding, or minor bleeding in patients with cancer. Further trials are needed to 
      evaluate the benefits and harms of different heparin thromboprophylaxis 
      strategies in this population more thoroughly.
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 - Sperati, Francesca
AU  - Sperati F
FAU - Neumann, Ignacio
AU  - Neumann I
FAU - Labedi, Nawman
AU  - Labedi N
FAU - Terrenato, Irene
AU  - Terrenato I
FAU - Barba, Maddalena
AU  - Barba M
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 - 20140626
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
UOF - Cochrane Database Syst Rev. 2011;(11):CD009447. PMID: 22071865
CIN - JAMA. 2015 Apr 7;313(13):1364-5. PMID: 25849181
UIN - Cochrane Database Syst Rev. 2018 Jul 11;7:CD009447. PMID: 29993117
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  - Randomized Controlled Trials as Topic
MH  - Thrombocytopenia/prevention & control
MH  - Thrombosis/mortality/*prevention & control
MH  - Venous Thrombosis/prevention & control
EDAT- 2014/06/27 06:00
MHDA- 2015/10/03 06:00
CRDT- 2014/06/27 06:00
PHST- 2014/06/27 06:00 [entrez]
PHST- 2014/06/27 06:00 [pubmed]
PHST- 2015/10/03 06:00 [medline]
AID - 10.1002/14651858.CD009447.pub2 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2014 Jun 26;(6):CD009447. doi: 
      10.1002/14651858.CD009447.pub2.