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| [PMID]: | 29363105 |
| [Au] Autor: | Hakoum MB; Kahale LA; Tsolakian IG; Matar CF; Yosuico VE; Terrenato I; Sperati F; Barba M; Schünemann H; Akl EA |
| [Ad] Endereço: | Family Medicine, American University of Beirut, Beirut, Lebanon, 1107 2020. |
| [Ti] Título: | Anticoagulation for the initial treatment of venous thromboembolism in people with cancer. |
| [So] Source: | Cochrane Database Syst Rev;1:CD006649, 2018 01 24. | | [Is] ISSN: | 1469-493X |
| [Cp] País de publicação: | England |
| [La] Idioma: | eng |
| [Ab] Resumo: | BACKGROUND: Compared with people without cancer, people with cancer who receive anticoagulant treatment for venous thromboembolism (VTE) are more likely to develop recurrent VTE. OBJECTIVES: To compare the efficacy and safety of three types of parenteral anticoagulants (i.e. fixed-dose low molecular weight heparin (LMWH), adjusted-dose unfractionated heparin (UFH), and fondaparinux) for the initial treatment of VTE in people with cancer. SEARCH METHODS: A comprehensive search included a major electronic search of the following databases: Cochrane Central Register of Controlled Trials (CENTRAL) (2018, Issue 1), MEDLINE (via Ovid) and Embase (via Ovid); handsearching of conference proceedings; checking of references of included studies; use of the 'related citation' feature in PubMed; and a search for ongoing studies. This update of the systematic review was based on the findings of a literature search conducted on 14 January 2018. SELECTION CRITERIA: Randomized controlled trials (RCTs) assessing the benefits and harms of LMWH, UFH, and fondaparinux in people with cancer and objectively confirmed VTE. DATA COLLECTION AND ANALYSIS: Using a standardized form, we extracted data in duplicate on study design, participants, interventions outcomes of interest, and risk of bias. Outcomes of interested included all-cause mortality, symptomatic VTE, major bleeding, minor bleeding, postphlebitic syndrome, quality of life, and thrombocytopenia. We assessed the certainty of evidence for each outcome using the GRADE approach. MAIN RESULTS: Of 15440 identified citations, 7387 unique citations, 15 RCTs fulfilled the eligibility criteria. These trials enrolled 1615 participants with cancer and VTE: 13 compared LMWH with UFH enrolling 1025 participants, one compared fondaparinux with UFH and LMWH enrolling 477 participants, and one compared dalteparin with tinzaparin enrolling 113 participants. The meta-analysis of mortality at three months included 418 participants from five studies and that of recurrent VTE included 422 participants from 3 studies. The findings showed that LMWH likely decreases mortality at three months compared to UFH (risk ratio (RR) 0.66, 95% confidence interval (CI) 0.40 to 1.10; risk difference (RD) 57 fewer per 1000, 95% CI 101 fewer to 17 more; moderate certainty evidence), but did not rule out a clinically significant increase or decrease in VTE recurrence (RR 0.69, 95% CI 0.27 to 1.76; RD 30 fewer per 1000, 95% CI 70 fewer to 73 more; moderate certainty evidence).The study comparing fondaparinux with heparin (UFH or LMWH) did not exclude a beneficial or detrimental effect of fondaparinux on mortality at three months (RR 1.25, 95% CI 0.86 to 1.81; RD 43 more per 1000, 95% CI 24 fewer to 139 more; moderate certainty evidence), recurrent VTE (RR 0.93, 95% CI 0.56 to 1.54; RD 8 fewer per 1000, 95% CI 52 fewer to 63 more; moderate certainty evidence), major bleeding (RR 0.82, 95% CI 0.40 to 1.66; RD 12 fewer per 1000, 95% CI 40 fewer to 44 more; moderate certainty evidence), or minor bleeding (RR 1.53, 95% CI 0.88 to 2.66; RD 42 more per 1000, 95% CI 10 fewer to 132 more; moderate certainty evidence)The study comparing dalteparin with tinzaparin did not exclude a beneficial or detrimental effect of dalteparin on mortality (RR 0.86, 95% CI 0.43 to 1.73; RD 33 fewer per 1000, 95% CI 135 fewer to 173 more; low certainty evidence), recurrent VTE (RR 0.44, 95% CI 0.09 to 2.16; RD 47 fewer per 1000, 95% CI 77 fewer to 98 more; low certainty evidence), major bleeding (RR 2.19, 95% CI 0.20 to 23.42; RD 20 more per 1000, 95% CI 14 fewer to 380 more; low certainty evidence), or minor bleeding (RR 0.82, 95% CI 0.30 to 2.21; RD 24 fewer per 1000, 95% CI 95 fewer to 164 more; low certainty evidence). AUTHORS' CONCLUSIONS: LMWH is possibly superior to UFH in the initial treatment of VTE in people with cancer. Additional trials focusing on patient-important outcomes will further inform the questions addressed in this review. The decision for a person with cancer to start LMWH therapy should balance the benefits and harms and consider the person's values and preferences. |
| [Mh] Termos MeSH primário: |
Anticoagulantes/uso terapêutico
Neoplasias/complicações
Tromboembolia Venosa/tratamento farmacológico
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| [Mh] Termos MeSH secundário: |
Dalteparina/uso terapêutico
Fibrinolíticos/uso terapêutico
Hemorragia/induzido quimicamente
Heparina/uso terapêutico
Heparina de Baixo Peso Molecular/uso terapêutico
Seres Humanos
Polissacarídeos/uso terapêutico
Ensaios Clínicos Controlados Aleatórios como Assunto
Recidiva
Prevenção Secundária
Tromboembolia Venosa/mortalidade
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| [Pt] Tipo de publicação: | JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW |
[Nm] Nome de substância:
| 0 (Anticoagulants); 0 (Fibrinolytic Agents); 0 (Heparin, Low-Molecular-Weight); 0 (Polysaccharides); 7UQ7X4Y489 (tinzaparin); 9005-49-6 (Heparin); J177FOW5JL (fondaparinux); S79O08V79F (Dalteparin) |
| [Em] Mês de entrada: | 1802 |
| [Cu] Atualização por classe: | 180226 |
[Lr] Data última revisão:
| 180226 |
| [Sb] Subgrupo de revista: | IM |
| [Da] Data de entrada para processamento: | 180125 |
| [St] Status: | MEDLINE |
| [do] DOI: | 10.1002/14651858.CD006649.pub7 |
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