Akl Elie A, Barba Maddalena, Rohilla Sandeep, Terrenato Irene, Sperati Francesca, Muti Paola, Schünemann Holger J
Department of Medicine, State University of New York at Buffalo, Buffalo, NY, USA.
J Exp Clin Cancer Res. 2008 Jul 18;27(1):21. doi: 10.1186/1756-9966-27-21.
Cancer and its therapies increase the risk of venous thromboembolism. Compared to patients without cancer, patients with cancer anticoagulated for venous thromboembolism are more likely to develop recurrent thrombotic events and major bleeding. Addressing all important outcomes including harm is of great importance to make evidence based health care decisions. The objective of this study was to compare low molecular weight heparin (LMWH) and oral anticoagulants (vitamin K antagonist (VKA) and ximelagatran) for the long term treatment of venous thromboembolism in patients with cancer.
A systematic review of the medical literature. We followed the Cochrane Collaboration methodology for conducting systematic reviews. We assessed methodological quality for each outcome by grading the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.
Eight randomized controlled trials (RCTs) were eligible and reported data for patients with cancer. The quality of evidence was low for death and moderate for recurrent venous thromboembolism. LMWH, compared to VKA provided no statistically significant survival benefit (Hazard ratio (HR) = 0.96; 95% CI 0.81 to 1.14) but a statistically significant reduction in venous thromboembolism (HR = 0.47; 95% (Confidence Interval (CI) = 0.32 to 0.71). There was no statistically significant difference between LMWH and VKA in bleeding outcomes (RR = 0.91; 95% CI = 0.64 to 1.31) or thrombocytopenia (RR = 1.02; 95% CI = 0.60 to 1.74).
For the long term treatment of venous thromboembolism in patients with cancer, LMWH compared to VKA reduces venous thromboembolism but not death.
癌症及其治疗方法会增加静脉血栓栓塞的风险。与无癌症患者相比，因静脉血栓栓塞接受抗凝治疗的癌症患者更易发生复发性血栓事件和严重出血。在做出基于证据的医疗保健决策时，考虑包括危害在内的所有重要结果非常重要。本研究的目的是比较低分子量肝素（LMWH）与口服抗凝剂（维生素K拮抗剂（VKA）和希美加群）对癌症患者静脉血栓栓塞的长期治疗效果。
对医学文献进行系统评价。我们遵循Cochrane协作网的方法进行系统评价。我们使用推荐分级评估、制定与评价（GRADE）方法对证据质量进行分级，以评估每个结果的方法学质量。
八项随机对照试验（RCT）符合条件并报告了癌症患者的数据。死亡证据质量低，复发性静脉血栓栓塞证据质量中等。与VKA相比，LMWH在生存获益方面无统计学显著差异（风险比（HR）=0.96；95%置信区间（CI）为0.81至1.14），但在静脉血栓栓塞方面有统计学显著降低（HR = 0.47；95%置信区间（CI）= 0.32至0.71）。LMWH与VKA在出血结局（RR = 0.91；95% CI = 0.64至1.31）或血小板减少症（RR = 1.02；95% CI = 0.60至1.74）方面无统计学显著差异。
对于癌症患者静脉血栓栓塞的长期治疗，与VKA相比，LMWH可降低静脉血栓栓塞，但不能降低死亡率。
