Akl Elie A, Labedi Nawman, Terrenato Irene, Barba Maddalena, Sperati Francesca, Sempos Elena V, Muti Paola, Cook Deborah, Schünemann Holger
Department of Medicine, State University of New York at Buffalo, Buffalo, NY, USA.
Cochrane Database Syst Rev. 2011 Nov 9(11):CD009447. doi: 10.1002/14651858.CD009447.
The choice of the appropriate perioperative thromboprophylaxis in patients with cancer depends on the relative benefits and harms of low molecular weight heparin (LMWH) and unfractionated heparin (UFH).
To systematically review the evidence for the relative efficacy and safety of LMWH and UFH for perioperative thromboprophylaxis in patients with cancer.
A comprehensive search for trials of anticoagulation in cancer patients including a February 2010 electronic search of: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and ISI Web of Science.
Randomized controlled trials (RCTs) that enrolled cancer patients undergoing a surgical intervention and compared the effects of LMWH to UFH on mortality, deep venous thrombosis (DVT), pulmonary embolism (PE), bleeding outcomes, and thrombocytopenia.
Two review authors used a standardized form to independently extract in duplicate data on risk of bias, participants, interventions and outcomes of interest. Where possible, we conducted meta-analyses using the random-effects model.
Of 8187 identified citations, we included 16 RCTs with 11,847 patients in the meta-analyses, all using preoperative prophylactic anticoagulation. The overall quality of evidence was moderate. The meta-analysis did not conclusively rule out either a beneficial or harmful effect of LMWH compared to UFH for the following outcomes: mortality (RR = 0.90; 95% CI 0.73 to 1.10), symptomatic DVT (RR = 0.73; 95% CI 0.23 to 2.28), PE (RR = 0.59; 95% CI 0.25 to1.41), minor bleeding (RR = 0.88; 95% CI 0.47 to 1.66) and major bleeding (RR = 0.84; 95% CI 0.52 to 1.36). LMWH was associated with lower incidence of wound hematoma (RR = 0.60; 95% CI 0.43, 0.84) while UFH was associated with higher incidence of intra-operative transfusion (RR = 1.16; 95% CI 0.69,1.62).
AUTHORS' CONCLUSIONS: We found no difference between perioperative thromboprophylaxis with LMWH verus UFH in their effects on mortality and embolic outcomes in patients with cancer. Further trials are needed to more carefully evaluate the benefits and harms of different heparin thromboprophylaxis strategies in this population.
癌症患者围手术期血栓预防措施的选择取决于低分子量肝素（LMWH）和普通肝素（UFH）的相对利弊。
系统评价LMWH和UFH用于癌症患者围手术期血栓预防的相对疗效和安全性的证据。
全面检索癌症患者抗凝治疗试验，包括2010年2月对以下数据库的电子检索：Cochrane对照试验中心注册库（CENTRAL）、MEDLINE、EMBASE和ISI科学网。
纳入接受手术干预的癌症患者的随机对照试验（RCT），比较LMWH与UFH对死亡率、深静脉血栓形成（DVT）、肺栓塞（PE）、出血结局和血小板减少症的影响。
两位综述作者使用标准化表格独立重复提取关于偏倚风险、研究对象、干预措施和感兴趣结局的数据。在可能的情况下，我们使用随机效应模型进行荟萃分析。
在检索到的8187篇文献中，我们在荟萃分析中纳入了16项RCT，共11847例患者，均采用术前预防性抗凝治疗。证据的总体质量为中等。荟萃分析未明确排除LMWH与UFH相比在以下结局方面的有益或有害影响：死亡率（RR = 0.90；95%CI 0.73至1.10）、有症状的DVT（RR = 0.73；95%CI 0.23至2.28）、PE（RR = 0.59；95%CI 0.25至1.41）、轻微出血（RR = 0.88；95%CI 0.47至1.66）和大出血（RR = 0.84；95%CI 0.52至1.36）。LMWH与伤口血肿发生率较低相关（RR = 0.60；95%CI 0.43，0.84），而UFH与术中输血发生率较高相关（RR = 1.16；95%CI 0.69，1.62）。
我们发现LMWH与UFH在癌症患者围手术期血栓预防中对死亡率和栓塞结局的影响无差异。需要进一步的试验来更仔细地评估该人群中不同肝素血栓预防策略的利弊。
