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Evidence summaries

Parenteral Anticoagulation in Ambulatory Patients with Cancer

Low molecular weightheparin (LMWH) reduces symptomatic venous thromboembolism and increases minor bleeding events in ambulatory cancer patients with no standard therapeutic or prophylactic indication for anticoagulation. LMWH appears to have a survival benefit in patients with small cell lung cancer at 12 months. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 19 studies with a total of 9 650 subjects. In all included RCTs, the intervention consisted of heparin (either unfractionated heparin or low molecular weight heparin). Overall, heparin appears to have no effect on mortality at 12 months (risk ratio (RR) 0.98; 95% confidence interval (CI) 0.93 to 1.03; risk difference (RD) 10 fewer per 1000; 95% CI 35 fewer to 15 more; moderate certainty of evidence) and mortality at 24 months (RR 0.99; 95% CI 0.96 to 1.01; RD 8 fewer per 1000; 95% CI 31 fewer to 8 more; moderate certainty of evidence). Heparin therapy reduces the risk of symptomatic VTE (RR 0.56; 95% CI 0.47 to 0.68; RD 30 fewer per 1000; 95% CI 36 fewer to 22 fewer; high certainty of evidence), while it increases in the risks of major bleeding (RR 1.30; 95% 0.94 to 1.79; RD 4 more per 1000; 95% CI 1 fewer to 11 more; moderate certainty of evidence) and minor bleeding (RR 1.70; 95% 1.13 to 2.55; RD 17 more per 1000; 95% CI 3 more to 37 more; high certainty of evidence). Results failed to confirm or to exclude a beneficial or detrimental effect of heparin on thrombocytopenia (RR 0.69; 95% CI 0.37 to 1.27; RD 33 fewer per 1000; 95% CI 66 fewer to 28 more; moderate certainty of evidence); quality of life (moderate certainty of evidence).

    References

    • Akl EA, Kahale LA, Hakoum MB et al. Parenteral anticoagulation in ambulatory patients with cancer. Cochrane Database Syst Rev 2017;(9):CD006652. [PubMed]

Primary/Secondary Keywords