Anticoagulation for the initial treatment of venous thromboembolism in patients with cancer.

Elie A. Akl, Srinivasa Rao Vasireddi, Sameer Gunukula, Maddalena Barba, Francesca Sperati, Irene Terrenato, Paola Muti, Holger Schünemann

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Compared to patients without cancer, patients with cancer who receive anticoagulant treatment for venous thromboembolism are more likely to develop recurrent venous thromboembolism (VTE). To compare the efficacy and safety of three types of parenteral anticoagulants for the initial treatment of VTE in patients with cancer. A comprehensive search for studies of anticoagulation in cancer patients including a February 2010 electronic search of: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and ISI Web of Science. Randomized clinical trials (RCTs) comparing low molecular weight heparin (LMWH), unfractionated heparin (UFH), and fondaparinux in patients with cancer and objectively confirmed VTE. Using a standardized data form, data was extracted in duplicate on methodological quality, participants, interventions, and outcomes of interest that included mortality, recurrent VTE, major bleeding, minor bleeding, postphlebitic syndrome, quality of life, and thrombocytopenia. Of 3986 identified citations, 16 RCTs were eligible: 13 compared LMWH to UFH, two compared fondaparinux to heparin, and one compared dalteparin to tinzaparin. Meta-analysis of 11 studies showed a statistically significant reduction in mortality at three months of follow up with LMWH compared with UFH (relative risk (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 methodological 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 death (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 to tinzaparin did not find a statistically significant difference in mortality (RR 0.86; 95% CI 0.43 to 1.73). 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.

Original languageEnglish
JournalThe Cochrane database of systematic reviews
Volume2
Publication statusPublished - 2011

Fingerprint

Venous Thromboembolism
Heparin
Low Molecular Weight Heparin
Confidence Intervals
Neoplasms
Dalteparin
Hemorrhage
Therapeutics
Anticoagulants
Meta-Analysis
Mortality
Postphlebitic Syndrome
Randomized Controlled Trials
Publication Bias
MEDLINE
Thrombocytopenia
Quality of Life
Safety
Recurrence

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Akl, E. A., Vasireddi, S. R., Gunukula, S., Barba, M., Sperati, F., Terrenato, I., ... Schünemann, H. (2011). Anticoagulation for the initial treatment of venous thromboembolism in patients with cancer. The Cochrane database of systematic reviews, 2.

Anticoagulation for the initial treatment of venous thromboembolism in patients with cancer. / Akl, Elie A.; Vasireddi, Srinivasa Rao; Gunukula, Sameer; Barba, Maddalena; Sperati, Francesca; Terrenato, Irene; Muti, Paola; Schünemann, Holger.

In: The Cochrane database of systematic reviews, Vol. 2, 2011.

Research output: Contribution to journalArticle

Akl, EA, Vasireddi, SR, Gunukula, S, Barba, M, Sperati, F, Terrenato, I, Muti, P & Schünemann, H 2011, 'Anticoagulation for the initial treatment of venous thromboembolism in patients with cancer.', The Cochrane database of systematic reviews, vol. 2.
Akl, Elie A. ; Vasireddi, Srinivasa Rao ; Gunukula, Sameer ; Barba, Maddalena ; Sperati, Francesca ; Terrenato, Irene ; Muti, Paola ; Schünemann, Holger. / Anticoagulation for the initial treatment of venous thromboembolism in patients with cancer. In: The Cochrane database of systematic reviews. 2011 ; Vol. 2.
@article{aaad90fc23984c04a9692bd11d30da66,
title = "Anticoagulation for the initial treatment of venous thromboembolism in patients with cancer.",
abstract = "Compared to patients without cancer, patients with cancer who receive anticoagulant treatment for venous thromboembolism are more likely to develop recurrent venous thromboembolism (VTE). To compare the efficacy and safety of three types of parenteral anticoagulants for the initial treatment of VTE in patients with cancer. A comprehensive search for studies of anticoagulation in cancer patients including a February 2010 electronic search of: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and ISI Web of Science. Randomized clinical trials (RCTs) comparing low molecular weight heparin (LMWH), unfractionated heparin (UFH), and fondaparinux in patients with cancer and objectively confirmed VTE. Using a standardized data form, data was extracted in duplicate on methodological quality, participants, interventions, and outcomes of interest that included mortality, recurrent VTE, major bleeding, minor bleeding, postphlebitic syndrome, quality of life, and thrombocytopenia. Of 3986 identified citations, 16 RCTs were eligible: 13 compared LMWH to UFH, two compared fondaparinux to heparin, and one compared dalteparin to tinzaparin. Meta-analysis of 11 studies showed a statistically significant reduction in mortality at three months of follow up with LMWH compared with UFH (relative risk (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 methodological 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 death (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 to tinzaparin did not find a statistically significant difference in mortality (RR 0.86; 95{\%} CI 0.43 to 1.73). 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.",
author = "Akl, {Elie A.} and Vasireddi, {Srinivasa Rao} and Sameer Gunukula and Maddalena Barba and Francesca Sperati and Irene Terrenato and Paola Muti and Holger Sch{\"u}nemann",
year = "2011",
language = "English",
volume = "2",
journal = "Cochrane Database of Systematic Reviews",
issn = "1361-6137",
publisher = "John Wiley and Sons Ltd",

}

TY - JOUR

T1 - Anticoagulation for the initial treatment of venous thromboembolism in patients with cancer.

AU - Akl, Elie A.

AU - Vasireddi, Srinivasa Rao

AU - Gunukula, Sameer

AU - Barba, Maddalena

AU - Sperati, Francesca

AU - Terrenato, Irene

AU - Muti, Paola

AU - Schünemann, Holger

PY - 2011

Y1 - 2011

N2 - Compared to patients without cancer, patients with cancer who receive anticoagulant treatment for venous thromboembolism are more likely to develop recurrent venous thromboembolism (VTE). To compare the efficacy and safety of three types of parenteral anticoagulants for the initial treatment of VTE in patients with cancer. A comprehensive search for studies of anticoagulation in cancer patients including a February 2010 electronic search of: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and ISI Web of Science. Randomized clinical trials (RCTs) comparing low molecular weight heparin (LMWH), unfractionated heparin (UFH), and fondaparinux in patients with cancer and objectively confirmed VTE. Using a standardized data form, data was extracted in duplicate on methodological quality, participants, interventions, and outcomes of interest that included mortality, recurrent VTE, major bleeding, minor bleeding, postphlebitic syndrome, quality of life, and thrombocytopenia. Of 3986 identified citations, 16 RCTs were eligible: 13 compared LMWH to UFH, two compared fondaparinux to heparin, and one compared dalteparin to tinzaparin. Meta-analysis of 11 studies showed a statistically significant reduction in mortality at three months of follow up with LMWH compared with UFH (relative risk (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 methodological 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 death (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 to tinzaparin did not find a statistically significant difference in mortality (RR 0.86; 95% CI 0.43 to 1.73). 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.

AB - Compared to patients without cancer, patients with cancer who receive anticoagulant treatment for venous thromboembolism are more likely to develop recurrent venous thromboembolism (VTE). To compare the efficacy and safety of three types of parenteral anticoagulants for the initial treatment of VTE in patients with cancer. A comprehensive search for studies of anticoagulation in cancer patients including a February 2010 electronic search of: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and ISI Web of Science. Randomized clinical trials (RCTs) comparing low molecular weight heparin (LMWH), unfractionated heparin (UFH), and fondaparinux in patients with cancer and objectively confirmed VTE. Using a standardized data form, data was extracted in duplicate on methodological quality, participants, interventions, and outcomes of interest that included mortality, recurrent VTE, major bleeding, minor bleeding, postphlebitic syndrome, quality of life, and thrombocytopenia. Of 3986 identified citations, 16 RCTs were eligible: 13 compared LMWH to UFH, two compared fondaparinux to heparin, and one compared dalteparin to tinzaparin. Meta-analysis of 11 studies showed a statistically significant reduction in mortality at three months of follow up with LMWH compared with UFH (relative risk (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 methodological 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 death (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 to tinzaparin did not find a statistically significant difference in mortality (RR 0.86; 95% CI 0.43 to 1.73). 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.

UR - http://www.scopus.com/inward/record.url?scp=79953003912&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79953003912&partnerID=8YFLogxK

M3 - Article

VL - 2

JO - Cochrane Database of Systematic Reviews

JF - Cochrane Database of Systematic Reviews

SN - 1361-6137

ER -