Article

Journal of Thrombosis and Thrombolysis

, Volume 38, Issue 2, pp 241-249

First online:

Primary venous thromboembolism prophylaxis in patients with solid tumors: a meta-analysis

  • Minh PhanAffiliated withInternal Medicine, University of Oklahoma Health Sciences Center
  • , Sonia JohnAffiliated withInternal Medicine, University of Oklahoma Health Sciences Center
  • , Ana I. CasanegraAffiliated withCardiovascular Medicine Section, University of Oklahoma Health Sciences Center
  • , Suman RathbunAffiliated withCardiovascular Medicine Section, University of Oklahoma Health Sciences Center
  • , Aaron MansfieldAffiliated withDepartment of Medical Oncology, Mayo Clinic
  • , Julie A. StonerAffiliated withDepartment of Biostatistics and Epidemiology, University of Oklahoma Health and Sciences Center
  • , Alfonso J. TafurAffiliated withCardiovascular Medicine Section, University of Oklahoma Health Sciences Center Email author 

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Abstract

Venous thromboembolism (VTE) is a leading cause of death among outpatient chemotherapy patients. However the VTE preventive measures for outpatients are not widely advocated. We did a meta-analysis to evaluate the outpatient VTE prevention’s effectiveness and safety. We searched electronic databases until the end of December 2012 and reviewed the abstracts and manuscripts following the PRISMA guidelines. Occurrence of first VTE event was the efficacy outcome. The safety end point was major bleeding. We calculated Q statistic and a homogeneity formal test. The odds ratio (OR) estimates were pooled by using the Mantel–Haenszel fixed-effects method in the absence of heterogeneity. Data were analyzed using the R META package). We identified 1,485 articles and reviewed 37 articles based on initial screening. The number of patients included in 11 selected trials was 7,805. The odds of VTE was lower in the prophylaxis group (OR 0.56; 95 % CI 0.45–0.71) and improved when heparin-based prevention was analyzed (OR 0.53; 95 % CI 0.41–0.70). We found strong prevention among patients with lung cancer (OR 0.46; 95 % CI 0.29–0.74) and pancreatic cancer (OR 0.33; 95 % CI 0.16–0.67). Major bleeding events were frequent in the intervention group (OR 1.65; 95 % CI 1.12–2.44). Thromboprophylaxis reduced VTE episodes. The VTE events were reduced by 47 % in heparin-based prophylaxis trials compared to placebo. The patients receiving heparin-based prophylaxis had a 60 % increase in bleeding events. Improving risk stratification tools to personalize prevention strategies may enhance the VTE prevention applicability in cancer patients.

Keywords

Cancer Thromboembolism Prevention