PMID- 27849664
OWN - NLM
STAT- MEDLINE
DCOM- 20170720
LR  - 20220317
IS  - 1528-1140 (Electronic)
IS  - 0003-4932 (Linking)
VI  - 265
IP  - 6
DP  - 2017 Jun
TI  - Perioperative Pharmacological Thromboprophylaxis in Patients With Cancer: A 
      Systematic Review and Meta-analysis.
PG  - 1087-1093
LID - 10.1097/SLA.0000000000002074 [doi]
AB  - OBJECTIVE: To compare the relative effects between pharmacological 
      thromboprophylaxis and no anticoagulation. BACKGROUND: The efficacy and safety of 
      pharmacological thromboprophylaxis in cancer patients undergoing surgery need to 
      be quantified to guide management. METHODS: We searched multiple electronic 
      databases (up to March 31, 2016) for trials of cancer patients undergoing surgery 
      that assessed the relative benefits and harms of perioperative pharmacological 
      thromboprophylaxis. Relative risks (RRs) with 95% confidence intervals (CI) were 
      estimated. RESULTS: A total of 39 studies were enrolled in this review. Patients 
      with pharmacological thromboprophylaxis had a relatively reduced incidence of 
      deep venous thrombosis (DVT) compared with those without (0.5% vs 1.2%, RR 0.51, 
      95% CI 0.27-0.94; P = 0.03) but a significantly increased incidence of bleeding 
      events (RR 2.51, 95% CI 1.79-3.51; P < 0.0001). The incidence of pulmonary 
      embolism (PE) (RR 1.77, 95% CI 0.76-4.14; P = 0.19) and mortality related to 
      venous thromboembolism (VTE) (1/2,811 vs 2/3,380) were similar between the 
      pharmacological thromboprophylaxis group and the no pharmacological 
      thromboprophylaxis group. Low-molecular-weight heparin (LMWH) reduced the 
      incidence of DVT compared with unfractionated heparin (UFH) (RR 0.81, 95% CI 
      0.66-1.00; P = 0.05), and standard extended thromboprophylaxis after cancer 
      surgery significant decreased the incidence of DVT as compared with conventional 
      thromboprophylaxis (RR 0.57, 95% CI 0.39-0.83; P = 0.003). CONCLUSIONS: Routine 
      pharmacological thromboprophylaxis for cancer patients undergoing surgery needs 
      to be carefully considered, because although thromboprophylaxis is associated 
      with lower VTE events, there is a higher incidence of clinically significant 
      bleeding events. If pharmacological thromboprophylaxis is to be used, extended 
      thromboprophylaxis started preoperatively with LWMH might be the most effective 
      strategy.
FAU - Guo, Qiang
AU  - Guo Q
AD  - Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu 
      , Sichuan Province, China.
FAU - Huang, Bin
AU  - Huang B
FAU - Zhao, Jichun
AU  - Zhao J
FAU - Ma, Yukui
AU  - Ma Y
FAU - Yuan, Ding
AU  - Yuan D
FAU - Yang, Yi
AU  - Yang Y
FAU - Du, Xiaojiong
AU  - Du X
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - Ann Surg
JT  - Annals of surgery
JID - 0372354
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Hemorrhage/chemically induced
MH  - Heparin/adverse effects/therapeutic use
MH  - Heparin, Low-Molecular-Weight/adverse effects/therapeutic use
MH  - Humans
MH  - Neoplasms/*surgery
MH  - Postoperative Complications/*prevention & control
MH  - Pulmonary Embolism/prevention & control
MH  - Venous Thromboembolism/*prevention & control
MH  - Venous Thrombosis/prevention & control
EDAT- 2016/11/17 06:00
MHDA- 2017/07/21 06:00
CRDT- 2016/11/17 06:00
PHST- 2016/11/17 06:00 [pubmed]
PHST- 2017/07/21 06:00 [medline]
PHST- 2016/11/17 06:00 [entrez]
AID - 10.1097/SLA.0000000000002074 [doi]
PST - ppublish
SO  - Ann Surg. 2017 Jun;265(6):1087-1093. doi: 10.1097/SLA.0000000000002074.