Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Ilam University of Medical Sciences, Ilam, Iran.
Asian Pac J Cancer Prev. 2024 Jul 1;25(7):2237-2246. doi: 10.31557/APJCP.2024.25.7.2237.
The role of anticoagulants in the primary prevention of venous Thromboembolism(VTE) in high-risk cancer patients has been proven in previous studies; however, the routine use of thromboprophylaxis in cancer patients with Khorana score≤ 2 is still debated. This systematic review and meta-analysis aimed to investigate the role of prophylaxis with anticoagulants in cancer patients with low to moderate risk for first time.
PubMed, Scopus, Google Scholar, and Web of Science databases were searched with Mesh terms to find Randomized controlled trial studies (RCTs) that evaluated the effect of thromboprophylaxis against placebo on VTE up to January 2024 in low-risk cancer patients. This systematic review was conducted based on the PRISMA guidelines. Heterogeneity between studies was evaluated using the I2 test. Egger's test was used to check publication bias. In general, 21 studies with 9985 participants were included.
The majority of studies had high quality and low risk of bias. The pooled estimate showed that using anticoagulants compared to placebo significantly reduces the risk of VTE (HR: 0.53, 95% CI: 0.43, 0.60, I2: 8.1%). Analysis of subgroups based on the class of anticoagulants showed that both direct oral anticoagulants (DOACs) (HR: 0.46, 95% CI: 0.36, 0.56, I2:8.5%) and Low molecular weight heparin (LMWH) (HR: 0.60, 95% CI: 0.51, 70, I2:0%) were significantly related to VTE risk compared to placebo. A pooled estimate of 18 studies did not show a significant association between increased major bleeding and anticoagulant prophylaxis. (HR: 1.25, 95% CI: 0.96, 1.54, I2: 4%).
Anticoagulant prophylaxis with both classes of LMWHs and DOACs compared to placebo can be associated with a reduction in VTE risk in low-to-intermediate risk cancer patients. DOACs were associated with a greater reduction in VTE risk. Anticoagulant prophylaxis had no significant relationship with increased major bleeding.
在以前的研究中已经证明，抗凝剂在高风险癌症患者的静脉血栓栓塞症（VTE）一级预防中的作用；然而，对于 Khorana 评分≤2 的癌症患者，常规使用血栓预防措施仍存在争议。本系统评价和荟萃分析旨在研究在低危至中危的癌症患者中，预防性使用抗凝剂的作用。
使用 MeSH 术语检索 PubMed、Scopus、Google Scholar 和 Web of Science 数据库，以查找截至 2024 年 1 月，评估在低危癌症患者中，与安慰剂相比，血栓预防对 VTE 影响的随机对照试验（RCT）。本系统评价是根据 PRISMA 指南进行的。使用 I2 检验评估研究之间的异质性。使用 Egger 检验检查发表偏倚。总共纳入了 21 项研究，共 9985 名参与者。
大多数研究质量较高，偏倚风险较低。汇总估计表明，与安慰剂相比，使用抗凝剂可显著降低 VTE 的风险（HR：0.53，95%CI：0.43，0.60，I2：8.1%）。基于抗凝剂种类的亚组分析表明，直接口服抗凝剂（DOACs）（HR：0.46，95%CI：0.36，0.56，I2：8.5%）和低分子肝素（LMWH）（HR：0.60，95%CI：0.51，0.70，I2：0%）与安慰剂相比，均与 VTE 风险显著相关。18 项研究的汇总估计显示，抗凝预防与大出血增加之间没有显著关联。（HR：1.25，95%CI：0.96，1.54，I2：4%）。
与安慰剂相比，LMWH 和 DOAC 两类抗凝预防均可降低低至中危癌症患者的 VTE 风险。DOAC 与 VTE 风险降低的相关性更大。抗凝预防与大出血增加无显著关系。
