Anticoagulation for the Prevention of Arterial Thromboembolism in Cancer Patients by Primary Tumor Site: A Systematic Review and Meta-Analysis of Randomized Trials.
Yan Xu,Caroline Mallity,Erin Collins,Deborah M Siegal,Tzu-Fei Wang,Marc Carrier
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引用次数: 0
Abstract
AIMS
Incidence of arterial thromboembolism (ATE) among ambulatory cancer patients varies by primary tumor site. However, it is unclear whether this alters the benefit-to-harm profile of prophylactic anticoagulation for ATE prevention. Therefore, we systematically evaluated the efficacy and safety of anticoagulants for ATE prevention among ambulatory cancer patients according to the primary tumor site.
METHODS AND RESULTS
We conducted a systematic review using Medline, Embase, SCOPUS, and CENTRAL, and included randomized trials comparing prophylactic anticoagulation to no anticoagulation among ambulatory cancer patients who initiated tumor-directed systemic therapy. Incidence of symptomatic ATE (acute ischemic stroke, acute myocardial infarction or peripheral artery occlusion) and major bleeding, as well as risk differences (RDs) attributable to anticoagulation were meta-analyzed by primary tumor site using random-effects modeling. We included 10 randomized controlled trials with 9,875 patients with follow-up ranging from 3.3 to 68 (median 6.6) months. While prophylactic anticoagulation did not reduce ATE risks overall (RD -0.49%; 95% CI -0.49% to 0.01%; I2=0%), it conferred a protective effect among pancreatic cancer patients (RD -3.2%; 95%CI -5.7% to -0.8%; I2=0%) without a detectable increase in major bleeding (RD -1.4%; 95% CI -4.6% to 1.8%; I2=0%). Prophylactic anticoagulation was not associated with ATE risk reduction in other tumor sites.
CONCLUSION
Based on available evidence, prophylactic anticoagulation did not reduce ATE risk among ambulatory cancer patients overall. However, we observed lower incidence of ATE among pancreatic cancer patients randomized to receive anticoagulation. Prophylactic anticoagulant use to reduce ATEs in pancreatic cancer should be evaluated in future research.
摘要门诊癌症患者的动脉血栓栓塞症(ATE)发病率因原发肿瘤部位而异。然而,目前还不清楚这是否会改变预防性抗凝治疗对预防 ATE 的利弊分析。因此,我们根据原发肿瘤部位系统地评估了非卧床癌症患者使用抗凝剂预防 ATE 的有效性和安全性。方法和结果我们使用 Medline、Embase、SCOPUS 和 CENTRAL 进行了系统性回顾,纳入了在开始接受肿瘤指导的全身治疗的非卧床癌症患者中比较预防性抗凝与无抗凝的随机试验。我们使用随机效应模型按原发肿瘤部位对无症状 ATE(急性缺血性中风、急性心肌梗死或外周动脉闭塞)和大出血的发生率以及抗凝引起的风险差异 (RD) 进行了元分析。我们纳入了 10 项随机对照试验,共有 9875 名患者参加,随访时间从 3.3 个月到 68 个月(中位数为 6.6 个月)不等。虽然预防性抗凝治疗并未降低总体ATE风险(RD -0.49%;95% CI -0.49%至0.01%;I2=0%),但它对胰腺癌患者具有保护作用(RD -3.2%;95%CI -5.7%至-0.8%;I2=0%),且未发现大出血增加(RD -1.4%;95% CI -4.6%至1.8%;I2=0%)。结论根据现有证据,预防性抗凝并不能降低门诊癌症患者的 ATE 风险。但是,我们观察到随机接受抗凝治疗的胰腺癌患者的 ATE 发生率较低。在未来的研究中,应该对预防性抗凝剂的使用以减少胰腺癌患者的 ATE 进行评估。
期刊介绍:
The European Heart Journal - Cardiovascular Pharmacotherapy (EHJ-CVP) is an international, peer-reviewed journal published in English, specifically dedicated to clinical cardiovascular pharmacology. EHJ-CVP publishes original articles focusing on clinical research involving both new and established drugs and methods, along with meta-analyses and topical reviews. The journal's primary aim is to enhance the pharmacological treatment of patients with cardiovascular disease by interpreting and integrating new scientific developments in this field.
While the emphasis is on clinical topics, EHJ-CVP also considers basic research articles from fields such as physiology and molecular biology that contribute to the understanding of cardiovascular drug therapy. These may include articles related to new drug development and evaluation, the physiological and pharmacological basis of drug action, metabolism, drug interactions, and side effects.