Meta-analysis on anticoagulation and prevention of thrombosis and mortality among patients with lung cancer

H. E. Fuentes, D. M. Oramas, L. H. Paz, A. I. Casanegra, Aaron Mansfield, A. J. Tafur

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13 Scopus citations

Abstract

Background Venous thromboembolism (Wickham et al., 2012 [1]) is a leading cause of morbidity and mortality among patients with cancer; however, primary thromboprophylaxis is not routinely recommended. We performed a systematic review and meta-analysis of randomized control trials (RCTs) to measure the impact of primary VTE prevention and its effect on mortality among patients with lung cancer. Methods With assistance from a master librarian, we searched Ovid, Scopus, DARE, CINAHL, MEDLINE, EMBASE, EBM reviews-Cochrane database of systematic reviews, EBM reviews-ACP journal, and EBM Reviews-Databases for relevant studies following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included articles addressing the role of anticoagulation in patients with lung cancer for primary VTE prevention for outpatients. The clinical outcomes were VTE occurrence, all-cause mortality, major and clinically relevant non-major bleeding. The results are presented as odds ratio (OR) and data were analyzed using R and R META package (Version 0.8–2, Author: Guido Schwarzer). Results Eleven studies with 5107 patients were included for the final analysis. We found 50% lower VTE occurrence in the prophylaxis group with low molecular weight heparin (LMWH) (OR: 0.50; 95% Confidence Interval (CI): 0.38–0.66; I2: 0%) without an increased bleeding risk (OR: 2.03; 95% CI: 0.78–5.25; I2: 71.1%). We found a mortality benefit when we grouped all VTE prevention modalities [LMWH, Warfarin, unfractionated heparin (UFH)] (OR: 0.75; 95% CI: 0.58–0.96; I2: 18.4%), but no significant difference when LMWH (OR: 0.74; 95% CI: 0.49–1.11; I2: 56.9%) and warfarin were analyzed individually (OR: 0.75; 95% CI: 0.47–1.21; I2: 0%). We found higher odds of bleeding combining all treatment modalities (OR: 3.06; 95% CI: 1.64–5.72; I2: 64.4%) with the greatest occurrence in the warfarin group (OR: 5.42; 95% CI: 3.48–8.45; I2: 45.7%). Conclusion Primary VTE prophylaxis with LMWH reduces the occurrence of VTE among ambulatory patients with lung cancer, without apparent increase in bleeding risk. There is a measurable mortality benefit of anticoagulation strategies that remains elusive when the analysis is restricted to a single agent.

Original languageEnglish (US)
Pages (from-to)28-34
Number of pages7
JournalThrombosis Research
Volume154
DOIs
StatePublished - Jun 1 2017

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Keywords

  • Anticoagulation
  • Lung cancer
  • Prevention
  • Systematic review
  • Thromboembolism

ASJC Scopus subject areas

  • Hematology

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