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The effectiveness and safety of thromboprophylaxis in cancer patients based on Khorana score: a meta-analysis and systematic review of randomized controlled trials

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Abstract

Introduction

Cancer patients receiving chemotherapy are a high risk of VTE, yet the importance of thromboprophylaxis for cancer patients that are at high risk of developing VTE is still controversial.

Aim

To calculate the benefits and harms of thromboprophylaxis, compared to placebo, in ambulatory high-risk cancer patients that are receiving chemotherapy.

Methods

We searched PubMed, Embase, Web of Science, the Cochrane Library, Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, WANFANG Data, Chinese National Knowledge Infrastructure and Chinese Scientific Journal Database for randomized controlled trials (RCTs) describing benefits and harms of thromboprophylaxis. Statistical analysis was performed using Stata software (version 15.1).

Results

We included six studies, which contained a total of 3240 cancer patients with thromboprophylaxis and 2874 cancer patients without thromboprophylaxis. Thromboprophylaxis was effective in high-risk patients with two points or higher (RR 0.51, 95% CI 0.36–0.71, I2 = 0.0%, P = 0.526). It was associated with an increase in bleeding events (RR 1.65, 95% CI 1.14–2.40, I2 = 0.0%, P = 0.498) and was mainly efficient in reducing the risk of pulmonary embolism (RR 0.56, 95% CI 0.33–0.96, I2 = 0.0%, P = 0.263). The risk of major (RR 1.85, 95% CI 0.87–3.94, I2 = 0.0%, P = 0.888) and non-major (RR 1.59, 95% CI 0.96–2.62, I2 = 16.3%, P = 0.303) bleeding showed no significant difference with or without thromboprophylaxis. There was no reduction in all-cause mortality with thromboprophylaxis (RR 0.95, 95% CI 0.78–1.18, I2 = 22.0%, P = 0.277).

Conclusion

Thromoboprophylaxis is effective and safe in cancer patients that are at high risk for developing VTE with chemotherapy.

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Funding

This work was not sponsored by any findings.

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Authors and Affiliations

  1. Institute of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Gansu, China

    Y. Bao, P. Yan & K. Yang

  2. Department of Pharmacy, Gansu Provincial Hospital, Gansu, China

    B. Gao

  3. Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, 730000, China

    L. Tian

  4. Evidence-Based Medicine Center, Lanzhou University, No. 199, West Road of Donggang Street, Lanzhou, 730000, China

    K. Yang

  5. Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China

    K. Yang

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  1. Y. Bao
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  4. L. Tian
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  5. K. Yang
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Contributions

KHY and LMT was involved in the design of the study. YB and BG collected the data. YB and BG performed the meta-analysis and wrote the first draft of the manuscript, which was critically revised by YB, BG, PJY, LMT and KHY.

Corresponding authors

Correspondence to L. Tian or K. Yang.

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Conflict of interest

None of the authors has anything to declare. The views expressed are those of the authors.

Ethical approval

This meta-analysis was based on a literature review and modeling techniques, so this study did not require approval by an Institutional Research Ethics Board.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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No additional data are available.

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Bao, Y., Gao, B., Yan, P. et al. The effectiveness and safety of thromboprophylaxis in cancer patients based on Khorana score: a meta-analysis and systematic review of randomized controlled trials. Clin Transl Oncol 22, 1992–2001 (2020). https://doi.org/10.1007/s12094-020-02336-4

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  • DOI: https://doi.org/10.1007/s12094-020-02336-4

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