PMID- 28402864
OWN - NLM
STAT- MEDLINE
DCOM- 20180312
LR  - 20181202
IS  - 1879-2472 (Electronic)
IS  - 0049-3848 (Linking)
VI  - 154
DP  - 2017 Jun
TI  - Meta-analysis on anticoagulation and prevention of thrombosis and mortality among 
      patients with lung cancer.
PG  - 28-34
LID - S0049-3848(17)30250-5 [pii]
LID - 10.1016/j.thromres.2017.03.024 [doi]
AB  - BACKGROUND: Venous thromboembolism (Wickham et al., 2012 [1]) is a leading cause 
      of morbidity and mortality among patients with cancer; however, primary 
      thromboprophylaxis is not routinely recommended. We performed a systematic review 
      and meta-analysis of randomized control trials (RCTs) to measure the impact of 
      primary VTE prevention and its effect on mortality among patients with lung 
      cancer. METHODS: With assistance from a master librarian, we searched Ovid, 
      Scopus, DARE, CINAHL, MEDLINE, EMBASE, EBM reviews-Cochrane database of 
      systematic reviews, EBM reviews-ACP journal, and EBM Reviews-Databases for 
      relevant studies following the Preferred Reporting Items for Systematic Reviews 
      and Meta-Analyses (PRISMA) guidelines. We included articles addressing the role 
      of anticoagulation in patients with lung cancer for primary VTE prevention for 
      outpatients. The clinical outcomes were VTE occurrence, all-cause mortality, 
      major and clinically relevant non-major bleeding. The results are presented as 
      odds ratio (OR) and data were analyzed using R and R META package (Version 0.8-2, 
      Author: Guido Schwarzer). RESULTS: Eleven studies with 5107 patients were 
      included for the final analysis. We found 50% lower VTE occurrence in the 
      prophylaxis group with low molecular weight heparin (LMWH) (OR: 0.50; 95% 
      Confidence Interval (CI): 0.38-0.66; I2: 0%) without an increased bleeding risk 
      (OR: 2.03; 95% CI: 0.78-5.25; I2: 71.1%). We found a mortality benefit when we 
      grouped all VTE prevention modalities [LMWH, Warfarin, unfractionated heparin 
      (UFH)] (OR: 0.75; 95% CI: 0.58-0.96; I2: 18.4%), but no significant difference 
      when LMWH (OR: 0.74; 95% CI: 0.49-1.11; I2: 56.9%) and warfarin were analyzed 
      individually (OR: 0.75; 95% CI: 0.47-1.21; I2: 0%). We found higher odds of 
      bleeding combining all treatment modalities (OR: 3.06; 95% CI: 1.64-5.72; I2: 
      64.4%) with the greatest occurrence in the warfarin group (OR: 5.42; 95% CI: 
      3.48-8.45; I2: 45.7%). CONCLUSION: Primary VTE prophylaxis with LMWH reduces the 
      occurrence of VTE among ambulatory patients with lung cancer, without apparent 
      increase in bleeding risk. There is a measurable mortality benefit of 
      anticoagulation strategies that remains elusive when the analysis is restricted 
      to a single agent.
CI  - Copyright (c) 2017 Elsevier Ltd. All rights reserved.
FAU - Fuentes, H E
AU  - Fuentes HE
AD  - Department of Internal Medicine, John Stroger Jr. Hospital, Chicago, IL, United 
      States.
FAU - Oramas, D M
AU  - Oramas DM
AD  - Department of Pathology, University of Illinois at Chicago, Chicago, IL, United 
      States.
FAU - Paz, L H
AU  - Paz LH
AD  - Department of Internal Medicine, John Stroger Jr. Hospital, Chicago, IL, United 
      States.
FAU - Casanegra, A I
AU  - Casanegra AI
AD  - Department of Cardiology - Vascular Medicine, Mayo Clinic, Rochester, MN, United 
      States.
FAU - Mansfield, A S
AU  - Mansfield AS
AD  - Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States.
FAU - Tafur, A J
AU  - Tafur AJ
AD  - Cardiology - Vascular Medicine, Northshore University Healthsystem, Evanston, IL, 
      United States. Electronic address: atafur@northshore.org.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20170401
PL  - United States
TA  - Thromb Res
JT  - Thrombosis research
JID - 0326377
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 5Q7ZVV76EI (Warfarin)
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  - Lung Neoplasms/*complications/mortality
MH  - Odds Ratio
MH  - Treatment Outcome
MH  - Venous Thromboembolism/*etiology/mortality/*prevention & control
MH  - Warfarin/adverse effects/*therapeutic use
OTO - NOTNLM
OT  - Anticoagulation
OT  - Lung cancer
OT  - Prevention
OT  - Systematic review
OT  - Thromboembolism
EDAT- 2017/04/14 06:00
MHDA- 2018/03/13 06:00
CRDT- 2017/04/14 06:00
PHST- 2017/02/10 00:00 [received]
PHST- 2017/03/20 00:00 [revised]
PHST- 2017/03/29 00:00 [accepted]
PHST- 2017/04/14 06:00 [pubmed]
PHST- 2018/03/13 06:00 [medline]
PHST- 2017/04/14 06:00 [entrez]
AID - S0049-3848(17)30250-5 [pii]
AID - 10.1016/j.thromres.2017.03.024 [doi]
PST - ppublish
SO  - Thromb Res. 2017 Jun;154:28-34. doi: 10.1016/j.thromres.2017.03.024. Epub 2017 
      Apr 1.