کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
6002193 1182966 2014 6 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Efficacy and Safety of Anticoagulant Therapy for the Treatment of Acute Cancer-Associated Thrombosis: A Systematic Review and Meta-Analysis
ترجمه فارسی عنوان
اثربخشی و ایمنی درمان ضد انعقاد برای درمان ترومبوز وابسته به سرطان حاد: یک بررسی منظم و متاآنالیز
کلمات کلیدی
ترومبوز وریدی، ترومبوآمبولی وریدی، آمبولی ریه وارفارین، هپارین، وزن کم مولکولی،
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی کاردیولوژی و پزشکی قلب و عروق
چکیده انگلیسی


- Low-molecular-weight-heparin (LMWH) monotherapy is associated with a significant reduction in the risk of recurrent VTE.
- Direct oral anticoagulants (DOACs) are associated with a non-significant lower risk of recurrent VTE.
- Cancer patient populations appear to be substantially different between the LMWH and DOACs trials.
- DOACs should not be used until trials comparing them to LMWH are conducted.

BackgroundCurrent clinical practice guidelines all recommend the use of therapeutic doses of low molecular weight heparins (LMWH) for the initial and long-term treatment of cancer-related thrombosis. The use of vitamin-K antagonists (VKA) is acceptable if LMWH is not available. Direct oral anticoagulants (DOACs) have been shown to be comparable to conventional therapy for the acute treatment of VTE but their efficacy and safety in cancer patients remains uncertain.MethodsA systematic literature search strategy was conducted using MEDLINE, EMBASE, and the EBM reviews. Randomized controlled trials (RCTs) reporting rates of recurrent VTE and major bleeding in cancer patients were included. Relative risks (RR) (95% confidence intervals (CI)) for these outcomes were generated.ResultsA total of 9 RCTs (2310 patients) were included in our analysis. In comparison to VKA, LMWH showed a significant reduction in recurrent VTE events (RR: 0.52; 95% CI: 0.36 to 0.74) whereas DOACs did not (RR: 0.66; 95% CI: 0.39 to 1.11). LMWH was associated with a non significant increase in the risk of major bleeding (RR: 1.06; 95% CI: 0.5 to 2.23) whereas DOACs showed a non significant reduction (RR: 0.78; 95% CI: 0.42 to 1.44). Annualized risks of recurrent VTE and major bleeding among patients randomized to VKA were higher in the LMWH studies as compared to the studies assessing DOACs suggesting that a higher risk cancer population were enrolled in the LMWH studies.ConclusionsLMWH should be used for the treatment of acute cancer-associated thrombosis. The use DOACs cannot be supported until trials comparing them to LMWH are conducted.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Thrombosis Research - Volume 134, Issue 6, December 2014, Pages 1214-1219
نویسندگان
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