TY - JOUR
T1 - Thromboprophylaxis for patients with cancer and central venous catheters
T2 - A systematic review and a meta-analysis
AU - Akl, Elie A.
AU - Kamath, Ganesh
AU - Yosuico, Victor
AU - Seo, Young Kim
AU - Barba, Maddalena
AU - Sperati, Francesca
AU - Cook, Deborah J.
AU - Schünemann, Holger J.
PY - 2008/6/1
Y1 - 2008/6/1
N2 - BACKGROUND. Central venous catheter (CVC) placement increases the risk of thrombosis and subsequent death in patients with cancer. The objective of this systematic review was to determine the efficacy and safety of anticoagulation in reducing mortality and thromboembolic events in cancer patients with a CVC. METHODS. The authors searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and ISI the Web of Science databases. They included randomized controlled trials in patients with cancer comparing unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), vitamin K antagonists, fondaparinux, or ximelagatran with no intervention, placebo, or each other. The standard methods of the Cochrane Collaboration were used for the analyses. RESULTS. Of 3986 identified citations we included 9 randomized clinical trials, none of which evaluated fondaparinux or ximelagatran. Heparin therapy (UFH or LMWH) was associated with a trend toward a reduction in symptomatic deep venous thrombosis (DVT) (relative risk (RR), 0.43; 95% confidence interval (95% CI), 0.18-1.06), but there was no statistically significant effect on mortality (RR, 0.74; 95% CI, 0.40-1.36), infection (RR, 0.91; 95% CI, 0.36-2.28), major bleeding (RR, 0.68; 95% CI, 0.10-4.78), or thrombocytopenia (RR, 0.85; 95% CI, 0.49-1.46). The effect of warfarin on symptomatic DVT also was not statistically significant (RR, 0.62; 95% CI, 0.30-1.27). CONCLUSIONS. The balance of benefits and downsides of thromboprophylaxis in cancer patients with CVC are uncertain. Clinicians together with their patients must weigh these factors carefully when making decisions regarding thromboprophylaxis.
AB - BACKGROUND. Central venous catheter (CVC) placement increases the risk of thrombosis and subsequent death in patients with cancer. The objective of this systematic review was to determine the efficacy and safety of anticoagulation in reducing mortality and thromboembolic events in cancer patients with a CVC. METHODS. The authors searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and ISI the Web of Science databases. They included randomized controlled trials in patients with cancer comparing unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), vitamin K antagonists, fondaparinux, or ximelagatran with no intervention, placebo, or each other. The standard methods of the Cochrane Collaboration were used for the analyses. RESULTS. Of 3986 identified citations we included 9 randomized clinical trials, none of which evaluated fondaparinux or ximelagatran. Heparin therapy (UFH or LMWH) was associated with a trend toward a reduction in symptomatic deep venous thrombosis (DVT) (relative risk (RR), 0.43; 95% confidence interval (95% CI), 0.18-1.06), but there was no statistically significant effect on mortality (RR, 0.74; 95% CI, 0.40-1.36), infection (RR, 0.91; 95% CI, 0.36-2.28), major bleeding (RR, 0.68; 95% CI, 0.10-4.78), or thrombocytopenia (RR, 0.85; 95% CI, 0.49-1.46). The effect of warfarin on symptomatic DVT also was not statistically significant (RR, 0.62; 95% CI, 0.30-1.27). CONCLUSIONS. The balance of benefits and downsides of thromboprophylaxis in cancer patients with CVC are uncertain. Clinicians together with their patients must weigh these factors carefully when making decisions regarding thromboprophylaxis.
KW - Anticoagulants
KW - Central venous catheterization
KW - Heparin
KW - Low-molecular-weight
KW - Neoplasms
KW - Thrombosis
KW - Venous thrombosis
KW - Warfarin
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U2 - 10.1002/cncr.23479
DO - 10.1002/cncr.23479
M3 - Article
C2 - 18404702
AN - SCOPUS:52049126660
VL - 112
SP - 2483
EP - 2492
JO - Cancer
JF - Cancer
SN - 0008-543X
IS - 11
ER -