Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA.
Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Blood Adv. 2021 Apr 27;5(8):2055-2062. doi: 10.1182/bloodadvances.2020004118.
Hospitalized medically ill patients with cancer are at increased risk of both venous thromboembolism and bleeding. The safety and efficacy of extended thromboprophylaxis in patients with cancer are unclear. We conducted a systematic review and meta-analysis of the literature using of MEDLINE, EMBASE, and the Cochrane CENTRAL databases to identify cancer subgroups enrolled in randomized controlled trials evaluating extended thromboprophylaxis following hospitalization. The primary outcomes were symptomatic and incidental venous thromboembolic events and hemorrhage (major hemorrhage and clinically relevant nonmajor bleeding). Four randomized controlled trials reported the outcomes of extended thromboprophylaxis in 3655 medically ill patients with active or history of cancer. The rates of venous thromboembolic events were similar between the extended-duration and standard-duration groups (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.61-1.18; I2 = 0%). However, major and clinically relevant nonmajor bleeding occurred significantly more frequently in the extended-duration thromboprophylaxis group (OR, 2.10; 95% CI, 1.33-3.35; I2 = 8%). Extended thromboprophylaxis in hospitalized medically ill patients with cancer was not associated with a reduced rate of venous thromboembolic events but was associated with increased risk of hemorrhage. This study protocol was registered on PROSPERO as #CRD42020209333.
患有癌症的住院病患者存在静脉血栓栓塞和出血的风险增加。癌症患者延长血栓预防的安全性和有效性尚不清楚。我们使用 MEDLINE、EMBASE 和 Cochrane CENTRAL 数据库进行了系统评价和文献荟萃分析，以确定在评估住院后延长血栓预防的随机对照试验中纳入的癌症亚组。主要结局是症状性和偶发性静脉血栓栓塞事件和出血（大出血和临床相关非大出血）。四项随机对照试验报告了 3655 名患有活动性或既往癌症的住院病患者延长血栓预防的结局。延长疗程和标准疗程组的静脉血栓栓塞事件发生率相似（比值比 [OR]，0.85；95%置信区间 [CI]，0.61-1.18；I2 = 0%）。然而，延长疗程的血栓预防组中主要和临床相关非大出血的发生率显著更高（OR，2.10；95% CI，1.33-3.35；I2 = 8%）。在患有癌症的住院病患者中延长血栓预防与降低静脉血栓栓塞事件发生率无关，但与出血风险增加相关。本研究方案已在 PROSPERO 上注册为 #CRD42020209333。
