Parenteral anticoagulation may prolong the survival of patients with limited small cell lung cancer: A Cochrane systematic review

Elie A. Akl, Frederiek F. Van Doormaal, Maddalena Barba, Ganesh Kamath, Seo Young Kim, Saskia Kuipers, Saskia Middeldorp, Victor Yosuico, Heather O. Dickinson, Holger J. Schünemann

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Abstract

Background. To determine the efficacy and safety of heparin (unfractionated heparin (UFH) or low-molecular-weight-heparin (LMWH)) and fondaparinux in improving the survival of patients with cancer. Methods. We conducted in January 2007 a comprehensive search for relevant randomized clinical trials (RCTs). We used a standardized form to extract in duplicate data on methodological quality, participants, interventions and outcomes of interest including all cause mortality, thromboembolic events, and bleeding events. We assessed the methodological quality for each outcome by grading the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results. Of 3986 identified citations, we included 5 RCTs, none of which evaluated fondaparinux. The quality of evidence was moderate for survival, low for major and minor bleeding, and very low for DVT. Heparin therapy was associated with a statistically and clinically significant survival benefit (hazard ratio (HR) = 0.77; 95%CI = 0.65-0.91). In subgroup analyses, patients with limited small cell lung cancer experienced a clear survival benefit (HR = 0.56; 95%CI = 0.38-0.83). The survival benefit was not statistically significant for either patients with extensive small cell lung cancer (HR = 0.80; 95%CI = 0.60-1.06) or patients with advanced cancer (HR = 0.84; 95%CI = 0.68-1.03). The increased risk of bleeding with heparin was not statistically significant (relative risk (RR) = 1.78; 95%CI = 0.73-4.38). Conclusion. This review suggests a survival benefit of heparin in cancer patients in general, and in patients with limited small cell lung cancer in particular.

Original languageEnglish
Article number4
JournalJournal of Experimental and Clinical Cancer Research
Volume27
Issue number1
DOIs
Publication statusPublished - 2008

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Small Cell Lung Carcinoma
Heparin
Survival
Hemorrhage
Randomized Controlled Trials
Neoplasms
Low Molecular Weight Heparin
Safety
Mortality

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Parenteral anticoagulation may prolong the survival of patients with limited small cell lung cancer : A Cochrane systematic review. / Akl, Elie A.; Van Doormaal, Frederiek F.; Barba, Maddalena; Kamath, Ganesh; Kim, Seo Young; Kuipers, Saskia; Middeldorp, Saskia; Yosuico, Victor; Dickinson, Heather O.; Schünemann, Holger J.

In: Journal of Experimental and Clinical Cancer Research, Vol. 27, No. 1, 4, 2008.

Research output: Contribution to journalArticle

Akl, EA, Van Doormaal, FF, Barba, M, Kamath, G, Kim, SY, Kuipers, S, Middeldorp, S, Yosuico, V, Dickinson, HO & Schünemann, HJ 2008, 'Parenteral anticoagulation may prolong the survival of patients with limited small cell lung cancer: A Cochrane systematic review', Journal of Experimental and Clinical Cancer Research, vol. 27, no. 1, 4. https://doi.org/10.1186/1756-9966-27-4
Akl, Elie A. ; Van Doormaal, Frederiek F. ; Barba, Maddalena ; Kamath, Ganesh ; Kim, Seo Young ; Kuipers, Saskia ; Middeldorp, Saskia ; Yosuico, Victor ; Dickinson, Heather O. ; Schünemann, Holger J. / Parenteral anticoagulation may prolong the survival of patients with limited small cell lung cancer : A Cochrane systematic review. In: Journal of Experimental and Clinical Cancer Research. 2008 ; Vol. 27, No. 1.
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abstract = "Background. To determine the efficacy and safety of heparin (unfractionated heparin (UFH) or low-molecular-weight-heparin (LMWH)) and fondaparinux in improving the survival of patients with cancer. Methods. We conducted in January 2007 a comprehensive search for relevant randomized clinical trials (RCTs). We used a standardized form to extract in duplicate data on methodological quality, participants, interventions and outcomes of interest including all cause mortality, thromboembolic events, and bleeding events. We assessed the methodological quality for each outcome by grading the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results. Of 3986 identified citations, we included 5 RCTs, none of which evaluated fondaparinux. The quality of evidence was moderate for survival, low for major and minor bleeding, and very low for DVT. Heparin therapy was associated with a statistically and clinically significant survival benefit (hazard ratio (HR) = 0.77; 95{\%}CI = 0.65-0.91). In subgroup analyses, patients with limited small cell lung cancer experienced a clear survival benefit (HR = 0.56; 95{\%}CI = 0.38-0.83). The survival benefit was not statistically significant for either patients with extensive small cell lung cancer (HR = 0.80; 95{\%}CI = 0.60-1.06) or patients with advanced cancer (HR = 0.84; 95{\%}CI = 0.68-1.03). The increased risk of bleeding with heparin was not statistically significant (relative risk (RR) = 1.78; 95{\%}CI = 0.73-4.38). Conclusion. This review suggests a survival benefit of heparin in cancer patients in general, and in patients with limited small cell lung cancer in particular.",
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T1 - Parenteral anticoagulation may prolong the survival of patients with limited small cell lung cancer

T2 - A Cochrane systematic review

AU - Akl, Elie A.

AU - Van Doormaal, Frederiek F.

AU - Barba, Maddalena

AU - Kamath, Ganesh

AU - Kim, Seo Young

AU - Kuipers, Saskia

AU - Middeldorp, Saskia

AU - Yosuico, Victor

AU - Dickinson, Heather O.

AU - Schünemann, Holger J.

PY - 2008

Y1 - 2008

N2 - Background. To determine the efficacy and safety of heparin (unfractionated heparin (UFH) or low-molecular-weight-heparin (LMWH)) and fondaparinux in improving the survival of patients with cancer. Methods. We conducted in January 2007 a comprehensive search for relevant randomized clinical trials (RCTs). We used a standardized form to extract in duplicate data on methodological quality, participants, interventions and outcomes of interest including all cause mortality, thromboembolic events, and bleeding events. We assessed the methodological quality for each outcome by grading the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results. Of 3986 identified citations, we included 5 RCTs, none of which evaluated fondaparinux. The quality of evidence was moderate for survival, low for major and minor bleeding, and very low for DVT. Heparin therapy was associated with a statistically and clinically significant survival benefit (hazard ratio (HR) = 0.77; 95%CI = 0.65-0.91). In subgroup analyses, patients with limited small cell lung cancer experienced a clear survival benefit (HR = 0.56; 95%CI = 0.38-0.83). The survival benefit was not statistically significant for either patients with extensive small cell lung cancer (HR = 0.80; 95%CI = 0.60-1.06) or patients with advanced cancer (HR = 0.84; 95%CI = 0.68-1.03). The increased risk of bleeding with heparin was not statistically significant (relative risk (RR) = 1.78; 95%CI = 0.73-4.38). Conclusion. This review suggests a survival benefit of heparin in cancer patients in general, and in patients with limited small cell lung cancer in particular.

AB - Background. To determine the efficacy and safety of heparin (unfractionated heparin (UFH) or low-molecular-weight-heparin (LMWH)) and fondaparinux in improving the survival of patients with cancer. Methods. We conducted in January 2007 a comprehensive search for relevant randomized clinical trials (RCTs). We used a standardized form to extract in duplicate data on methodological quality, participants, interventions and outcomes of interest including all cause mortality, thromboembolic events, and bleeding events. We assessed the methodological quality for each outcome by grading the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results. Of 3986 identified citations, we included 5 RCTs, none of which evaluated fondaparinux. The quality of evidence was moderate for survival, low for major and minor bleeding, and very low for DVT. Heparin therapy was associated with a statistically and clinically significant survival benefit (hazard ratio (HR) = 0.77; 95%CI = 0.65-0.91). In subgroup analyses, patients with limited small cell lung cancer experienced a clear survival benefit (HR = 0.56; 95%CI = 0.38-0.83). The survival benefit was not statistically significant for either patients with extensive small cell lung cancer (HR = 0.80; 95%CI = 0.60-1.06) or patients with advanced cancer (HR = 0.84; 95%CI = 0.68-1.03). The increased risk of bleeding with heparin was not statistically significant (relative risk (RR) = 1.78; 95%CI = 0.73-4.38). Conclusion. This review suggests a survival benefit of heparin in cancer patients in general, and in patients with limited small cell lung cancer in particular.

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