Thromboprophylaxis in Cancer Patients − Results of Current Meta-Analysis
A recently published meta-analysis shows the benefits of thromboprophylaxis in cancer patients, with no increased risk of severe bleeding complications.
Venous thromboembolism as a serious complication of cancer
Venous thromboembolism (VTE) is a serious complication of cancer. It is reported to complicate the course of the disease in 4−20% of cancer patients. The incidence of VTE in these patients is 4−7 times higher than in patients without cancer. VTE as a complication leads to prolonged hospitalization and is also associated with higher economic costs. It has been found that VTE complicates the care of cancer patients, can lead to longer interruptions in treatment or its postponement. The survival rate of patients with VTE is reported to be one-third that of other patients with cancer.
Analysis of the benefits and risks of thromboprophylaxis
From this perspective, thromboprophylaxis in cancer patients is certainly potentially beneficial. On the other hand, it may increase the risk of bleeding or the development of thrombocytopenia. The meta-analysis and systematic review of the available literature focused on defining the efficacy and safety of thromboprophylaxis in patients undergoing surgery for cancer or chemotherapy. Thirty-three studies with a total of 11,942 cancer patients were analyzed.
In cancer patients who underwent surgery, thromboprophylaxis administration was associated with a decreasing trend in the incidence of VTE (relative risk [RR] 0.51; 95% confidence interval [CI] 0.32−0.81) and deep vein thrombosis (RR 0.53; 95% CI 0.33−0.87). In patients undergoing chemotherapy, thromboprophylaxis administration was associated with a reduction in the incidence of VTE (RR 0.54; 95% CI 0.40−0.73), deep vein thrombosis (RR 0.47; 95% CI 0.31−0.73) and pulmonary embolism (RR 0.51; 95% CI 0.32−0.81).
Pooled results focusing on significant bleeding showed that there is no significant difference in bleeding between patients treated with thromboprophylaxis and those without.
Conclusion
According to this meta-analysis, thromboprophylaxis did not increase the risk of severe bleeding nor lead to an increased incidence of thrombocytopenia. Additionally, thromboprophylaxis reduced the number of VTE-related events in cancer patients without an apparent increase in the incidence of severe bleeding.
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Source: Liu M., Wang G., Li Y. et al. Efficacy and safety of thromboprophylaxis in cancer patients: a systematic review and meta-analysis. Ther Adv Med Oncol 2020; 12: 1758835920907540, doi: 10.1177/1758835920907540.
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