Anticoagulation for thrombosis prophylaxis in cancer patients with central venous catheters

Elie A. Akl, G. Karmath, V. Yosuico, S. Y. Kim, M. Barba, F. Sperati, D. Cook, H. J. Schünemann

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Background: Central venous catheter (CVC) placement increases the risk of thrombosis in cancer patients. Thrombosis often necessitates the removal of the CVC, resulting in treatment delays and thrombosis related morbidity and mortality. Objectives: To evaluate the efficacy and safety of anticoagulation in reducing venous thromboembolic (VTE) events in cancer patients with CVC. Search strategy: A comprehensive search for studies of anticoagulation in cancer patients up to January 2006 was conducted in the following databases: The Cochrane Central Register of Controlled Trials ( CENTRAL), MEDLINE, EMBASE and ISI the Web of Science. Selection criteria: Randomized controlled trials (RCTs) comparing unfractionated heparin (UFH), low molecular weight heparin (LMWH), vitamin K antagonists (VKA), fondaparinux or ximelagatran to no intervention or placebo in cancer patients with a CVC or comparing two different anticoagulants. Data collection and analysis: Data was extracted on methodological quality, patients, interventions and outcomes including all cause mortality (primary outcome), premature CVC removal, catheter-related infections, CVC site and non CVC site deep venous thrombosis (DVT), pulmonary embolism (PE), major and minor bleeding and thrombocytopenia. Main results: Of 3986 identified citations nine RCTs were included in the meta-analysis including one published as an abstract and one focusing on paediatric patients not included in the meta-analysis. None of these RCTs tested fondaparinux or ximelagatran. The use of heparin in cancer patients with CVC was associated with a trend towards a reduction in symptomatic DVT (Relative Risk (RR) = 0.43; 95% Confidence Interval (CI): 0.18 to 1.06), but the data did not show any statistically significant effect on mortality (RR = 0.74; 95% CI: 0.40 to 1.36), infection (RR = 0.91; 95% CI: 0.36 to 2.28), major bleeding (RR = 0.68; 95% CI: 0.10 to 4.78) or thrombocytopenia (RR = 0.85; 95% CI: 0.49 to 1.46). The effect warfarin on symptomatic DVT was not statistically significant (RR = 0.62; 95% CI: 0.30 to 1.27). When studies assessing different types of anticoagulants were pooled, symptomatic DVT rates were significantly reduced (RR = 0.56; 95% CI: 0.34 to 0.92). Authors' conclusions: Cancer patients with CVC considering anticoagulation, should consider the possible benefit of reduced incidence of thromboembolic complications against the burden and harms of anticoagulation. Future studies should be adequately powered and evaluate the effects of newer anticoagulants such as fondaparinux and ximelagatran in cancer patients with CVC.

Original languageEnglish
Article numberCD006468
JournalThe Cochrane database of systematic reviews
Issue number3
DOIs
Publication statusPublished - 2007

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Central Venous Catheters
Thrombosis
Confidence Intervals
Neoplasms
Venous Thrombosis
Anticoagulants
Randomized Controlled Trials
Thrombocytopenia
Heparin
Meta-Analysis
Mortality
Hemorrhage
Catheter-Related Infections
Vitamin K
Low Molecular Weight Heparin
Warfarin
Pulmonary Embolism
MEDLINE
Patient Selection
Placebos

Keywords

  • *Neoplasms
  • Anticoagulants [*therapeutic use]
  • Catheterization, central venous [*adverse effects]
  • Heparin [therapeutic use]
  • Heparin, low-molecular-weight [therapeutic use]
  • Randomized controlled trials as topic

ASJC Scopus subject areas

  • Medicine(all)
  • Pharmacology (medical)

Cite this

Akl, E. A., Karmath, G., Yosuico, V., Kim, S. Y., Barba, M., Sperati, F., ... Schünemann, H. J. (2007). Anticoagulation for thrombosis prophylaxis in cancer patients with central venous catheters. The Cochrane database of systematic reviews, (3), [CD006468]. https://doi.org/10.1002/14651858.CD006468.pub2

Anticoagulation for thrombosis prophylaxis in cancer patients with central venous catheters. / Akl, Elie A.; Karmath, G.; Yosuico, V.; Kim, S. Y.; Barba, M.; Sperati, F.; Cook, D.; Schünemann, H. J.

In: The Cochrane database of systematic reviews, No. 3, CD006468, 2007.

Research output: Contribution to journalArticle

Akl, Elie A. ; Karmath, G. ; Yosuico, V. ; Kim, S. Y. ; Barba, M. ; Sperati, F. ; Cook, D. ; Schünemann, H. J. / Anticoagulation for thrombosis prophylaxis in cancer patients with central venous catheters. In: The Cochrane database of systematic reviews. 2007 ; No. 3.
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abstract = "Background: Central venous catheter (CVC) placement increases the risk of thrombosis in cancer patients. Thrombosis often necessitates the removal of the CVC, resulting in treatment delays and thrombosis related morbidity and mortality. Objectives: To evaluate the efficacy and safety of anticoagulation in reducing venous thromboembolic (VTE) events in cancer patients with CVC. Search strategy: A comprehensive search for studies of anticoagulation in cancer patients up to January 2006 was conducted in the following databases: The Cochrane Central Register of Controlled Trials ( CENTRAL), MEDLINE, EMBASE and ISI the Web of Science. Selection criteria: Randomized controlled trials (RCTs) comparing unfractionated heparin (UFH), low molecular weight heparin (LMWH), vitamin K antagonists (VKA), fondaparinux or ximelagatran to no intervention or placebo in cancer patients with a CVC or comparing two different anticoagulants. Data collection and analysis: Data was extracted on methodological quality, patients, interventions and outcomes including all cause mortality (primary outcome), premature CVC removal, catheter-related infections, CVC site and non CVC site deep venous thrombosis (DVT), pulmonary embolism (PE), major and minor bleeding and thrombocytopenia. Main results: Of 3986 identified citations nine RCTs were included in the meta-analysis including one published as an abstract and one focusing on paediatric patients not included in the meta-analysis. None of these RCTs tested fondaparinux or ximelagatran. The use of heparin in cancer patients with CVC was associated with a trend towards a reduction in symptomatic DVT (Relative Risk (RR) = 0.43; 95{\%} Confidence Interval (CI): 0.18 to 1.06), but the data did not show any statistically significant effect on mortality (RR = 0.74; 95{\%} CI: 0.40 to 1.36), infection (RR = 0.91; 95{\%} CI: 0.36 to 2.28), major bleeding (RR = 0.68; 95{\%} CI: 0.10 to 4.78) or thrombocytopenia (RR = 0.85; 95{\%} CI: 0.49 to 1.46). The effect warfarin on symptomatic DVT was not statistically significant (RR = 0.62; 95{\%} CI: 0.30 to 1.27). When studies assessing different types of anticoagulants were pooled, symptomatic DVT rates were significantly reduced (RR = 0.56; 95{\%} CI: 0.34 to 0.92). Authors' conclusions: Cancer patients with CVC considering anticoagulation, should consider the possible benefit of reduced incidence of thromboembolic complications against the burden and harms of anticoagulation. Future studies should be adequately powered and evaluate the effects of newer anticoagulants such as fondaparinux and ximelagatran in cancer patients with CVC.",
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TY - JOUR

T1 - Anticoagulation for thrombosis prophylaxis in cancer patients with central venous catheters

AU - Akl, Elie A.

AU - Karmath, G.

AU - Yosuico, V.

AU - Kim, S. Y.

AU - Barba, M.

AU - Sperati, F.

AU - Cook, D.

AU - Schünemann, H. J.

PY - 2007

Y1 - 2007

N2 - Background: Central venous catheter (CVC) placement increases the risk of thrombosis in cancer patients. Thrombosis often necessitates the removal of the CVC, resulting in treatment delays and thrombosis related morbidity and mortality. Objectives: To evaluate the efficacy and safety of anticoagulation in reducing venous thromboembolic (VTE) events in cancer patients with CVC. Search strategy: A comprehensive search for studies of anticoagulation in cancer patients up to January 2006 was conducted in the following databases: The Cochrane Central Register of Controlled Trials ( CENTRAL), MEDLINE, EMBASE and ISI the Web of Science. Selection criteria: Randomized controlled trials (RCTs) comparing unfractionated heparin (UFH), low molecular weight heparin (LMWH), vitamin K antagonists (VKA), fondaparinux or ximelagatran to no intervention or placebo in cancer patients with a CVC or comparing two different anticoagulants. Data collection and analysis: Data was extracted on methodological quality, patients, interventions and outcomes including all cause mortality (primary outcome), premature CVC removal, catheter-related infections, CVC site and non CVC site deep venous thrombosis (DVT), pulmonary embolism (PE), major and minor bleeding and thrombocytopenia. Main results: Of 3986 identified citations nine RCTs were included in the meta-analysis including one published as an abstract and one focusing on paediatric patients not included in the meta-analysis. None of these RCTs tested fondaparinux or ximelagatran. The use of heparin in cancer patients with CVC was associated with a trend towards a reduction in symptomatic DVT (Relative Risk (RR) = 0.43; 95% Confidence Interval (CI): 0.18 to 1.06), but the data did not show any statistically significant effect on mortality (RR = 0.74; 95% CI: 0.40 to 1.36), infection (RR = 0.91; 95% CI: 0.36 to 2.28), major bleeding (RR = 0.68; 95% CI: 0.10 to 4.78) or thrombocytopenia (RR = 0.85; 95% CI: 0.49 to 1.46). The effect warfarin on symptomatic DVT was not statistically significant (RR = 0.62; 95% CI: 0.30 to 1.27). When studies assessing different types of anticoagulants were pooled, symptomatic DVT rates were significantly reduced (RR = 0.56; 95% CI: 0.34 to 0.92). Authors' conclusions: Cancer patients with CVC considering anticoagulation, should consider the possible benefit of reduced incidence of thromboembolic complications against the burden and harms of anticoagulation. Future studies should be adequately powered and evaluate the effects of newer anticoagulants such as fondaparinux and ximelagatran in cancer patients with CVC.

AB - Background: Central venous catheter (CVC) placement increases the risk of thrombosis in cancer patients. Thrombosis often necessitates the removal of the CVC, resulting in treatment delays and thrombosis related morbidity and mortality. Objectives: To evaluate the efficacy and safety of anticoagulation in reducing venous thromboembolic (VTE) events in cancer patients with CVC. Search strategy: A comprehensive search for studies of anticoagulation in cancer patients up to January 2006 was conducted in the following databases: The Cochrane Central Register of Controlled Trials ( CENTRAL), MEDLINE, EMBASE and ISI the Web of Science. Selection criteria: Randomized controlled trials (RCTs) comparing unfractionated heparin (UFH), low molecular weight heparin (LMWH), vitamin K antagonists (VKA), fondaparinux or ximelagatran to no intervention or placebo in cancer patients with a CVC or comparing two different anticoagulants. Data collection and analysis: Data was extracted on methodological quality, patients, interventions and outcomes including all cause mortality (primary outcome), premature CVC removal, catheter-related infections, CVC site and non CVC site deep venous thrombosis (DVT), pulmonary embolism (PE), major and minor bleeding and thrombocytopenia. Main results: Of 3986 identified citations nine RCTs were included in the meta-analysis including one published as an abstract and one focusing on paediatric patients not included in the meta-analysis. None of these RCTs tested fondaparinux or ximelagatran. The use of heparin in cancer patients with CVC was associated with a trend towards a reduction in symptomatic DVT (Relative Risk (RR) = 0.43; 95% Confidence Interval (CI): 0.18 to 1.06), but the data did not show any statistically significant effect on mortality (RR = 0.74; 95% CI: 0.40 to 1.36), infection (RR = 0.91; 95% CI: 0.36 to 2.28), major bleeding (RR = 0.68; 95% CI: 0.10 to 4.78) or thrombocytopenia (RR = 0.85; 95% CI: 0.49 to 1.46). The effect warfarin on symptomatic DVT was not statistically significant (RR = 0.62; 95% CI: 0.30 to 1.27). When studies assessing different types of anticoagulants were pooled, symptomatic DVT rates were significantly reduced (RR = 0.56; 95% CI: 0.34 to 0.92). Authors' conclusions: Cancer patients with CVC considering anticoagulation, should consider the possible benefit of reduced incidence of thromboembolic complications against the burden and harms of anticoagulation. Future studies should be adequately powered and evaluate the effects of newer anticoagulants such as fondaparinux and ximelagatran in cancer patients with CVC.

KW - Neoplasms

KW - Anticoagulants [therapeutic use]

KW - Catheterization, central venous [adverse effects]

KW - Heparin [therapeutic use]

KW - Heparin, low-molecular-weight [therapeutic use]

KW - Randomized controlled trials as topic

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U2 - 10.1002/14651858.CD006468.pub2

DO - 10.1002/14651858.CD006468.pub2

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JO - Cochrane Database of Systematic Reviews

JF - Cochrane Database of Systematic Reviews

SN - 1361-6137

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