Melina Verso, MD; Alfonso Iorio, MD
In patients with cancer, what is the relative effectiveness and safety of low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) for perioperative thromboprophylaxis?
Studies selected compared LMWH with UFH for perioperative thromboprophylaxis in patients with cancer. Outcomes included mortality, deep venous thrombosis (DVT), pulmonary embolism (PE), major and minor bleeding, and thrombocytopenia.
Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE/Excerpta Medica, and ISI the Web of Science (to Jan 2007); conference proceedings; reference lists; and the “related articles” feature of PubMed were searched for randomized controlled trials (RCTs). 14 RCTs (n = 5502) met the selection criteria. 6 trials reported adequate concealment of allocation, and 8 trials reported blinding. All trials used preoperative prophylactic anticoagulation.
Compared with UFH, LMWH reduced DVT (detected by clinical symptoms or screening with I125-fibrinogen scan, venography, ultrasonography, or impedance plethysmography) but not mortality (Table). Groups did not differ for symptomatic DVT (6 RCTs), PE (12 RCTs), major bleeding (6 RCTs), minor bleeding (3 RCTs), or thrombocytopenia (3 RCTs).
In patients with cancer having surgery, perioperative low-molecular-weight heparin does not reduce mortality more than unfractionated heparin but reduces risk for deep venous thrombosis, with no increase in bleeding.
Low-molecular-weight heparin (LMWH) vs unfractionated heparin (UFH) for perioperative thromboprophylaxis in patients with cancer*
*Abbreviations defined in Glossary. Weighted event rates, RRR, NNT, and CI calculated from data in article using a fixed-effects model for death and a random-effects model for deep venous thrombosis.
Melina Verso, Alfonso Iorio. Review: Perioperative LMW heparin does not reduce mortality after surgery more than unfractionated heparin in patients with cancer. Ann Intern Med. 2008;149:JC6–11. doi: 10.7326/0003-4819-149-12-200812160-02011
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Published: Ann Intern Med. 2008;149(12):JC6-11.
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