Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
Thromb Haemost. 2020 May;120(5):832-846. doi: 10.1055/s-0040-1709712. Epub 2020 May 5.
Low molecular weight heparins (LMWH) are often used as a first-line therapy for the prevention of thrombosis in cancer patients. Preclinical evidence from animal models suggests that LMWH may have antimetastatic properties. Clinical evidence of this effect is inconclusive. The objective of this systematic review is to evaluate the effect of LMWH on overall survival in patients with solid tumor malignancies.
MEDLINE, Embase, and The Cochrane Central Register of Controlled trials were searched from inception to November 26, 2018. We included randomized controlled trials that compared LMWH to placebo, a no-treatment arm, or a short-term prophylactic course of LMWH in adult patients with solid tumors. The primary outcome was overall survival. Secondary outcomes included progression-free survival, the occurrence of venous thromboembolism, and major bleeding events. The risk of bias was assessed in duplicate using the Cochrane Risk-of-Bias tool.
Forty-five articles were included in the review. Overall, no difference in overall survival was observed between groups (risk ratio: 1.00; 95% confidence interval: 0.98-1.02; I = 36.5%). In our defined subgroup analyses, the effect was not shown to vary by the type of LMWH, duration of LMWH use, length of study follow-up, comparator used in the study, or the setting in which the LMWH was administered. The majority of studies had an unclear risk of bias for at least one methodological criterion.
Although LMWH is thought to possess antimetastatic properties and thus have the potential to improve survival in cancer patients, existing data do not support this hypothesis.
低分子量肝素（LMWH）常用于预防癌症患者的血栓形成，作为一线治疗方法。来自动物模型的临床前证据表明，LMWH 可能具有抗转移特性。这种作用的临床证据尚无定论。本系统评价的目的是评估 LMWH 对实体瘤恶性肿瘤患者总生存率的影响。
从建库到 2018 年 11 月 26 日，我们在 MEDLINE、Embase 和 Cochrane 对照试验中心注册库中进行了检索。我们纳入了比较 LMWH 与安慰剂、无治疗组或短期预防性 LMWH 治疗成人实体瘤患者的随机对照试验。主要结局是总生存率。次要结局包括无进展生存率、静脉血栓栓塞的发生和大出血事件。使用 Cochrane 偏倚风险工具对偏倚风险进行了重复评估。
共纳入 45 篇文章。总体而言，两组间总生存率无差异（风险比：1.00；95%置信区间：0.98-1.02；I=36.5%）。在我们定义的亚组分析中，LMWH 的类型、LMWH 使用的持续时间、研究随访的长度、研究中使用的对照药物或 LMWH 的给药环境均不会影响治疗效果。大多数研究在至少一个方法学标准上存在不确定的偏倚风险。
尽管 LMWH 被认为具有抗转移特性，因此有可能改善癌症患者的生存率，但现有数据并不支持这一假设。
