Blood thinners to prevent blood clots in patients with cancer and central venous catheters

Akl EA, Vasireddi SRao, Gunukula S, Yosuico VE D, Barba M, Sperati F, Cook D, Schünemann H

Published Online:

April 13, 2011

Central venous catheter (CVC) placement increases the risk of blood clots in patients with cancer. This systematic review evaluates the efficacy and safety of blood thinning agents in these patients. In this systematic review, data from 12 trials and 3611 participants do not confirm nor rule out clinically important effects of these agents on death, blood clots or major bleeding. The main limitation of this systematic review is the inclusion of different types and stages of cancer.

Abstract (click to read)

Background:

Central venous catheter (CVC) placement increases the risk of thrombosis in cancer patients. Thrombosis often necessitates the removal of the CVC, resulting in treatment delays and thrombosis related morbidity and mortality.

Objectives:

To evaluate the efficacy and safety of anticoagulation in cancer patients with a CVC.

Search strategy:

We searched The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1 2010), MEDLINE (January 1966 to February 2010; accessed via OVID), EMBASE (January 1980 to February 2010; accessed via OVID) and ISI the Web of Science (1975 to February 2010). We handsearched conference proceedings, checked references of included studies and used the "related article" feature within PubMed.

Selection criteria:

Randomized controlled trials (RCTs) comparing any dose of unfractionated heparin (UFH), low molecular weight heparin (LMWH), vitamin K antagonists (VKA), or fondaparinux to no intervention or placebo or comparing two different anticoagulants in cancer patients with a CVC.

Data collection and analysis:

Two authors independently extracted data from each included study and resolved their disagreements by discussion.

Main results:

Of 8187 identified citations, we included 12 RCTs enrolling 3611 patients and assessing either prophylactic dose heparin or low dose VKAs. Prophylactic dose heparin was not associated with a statistically significant effect on death (relative risk (RR) = 0.85; 95% confidence interval (CI): 0.53 to 1.37), symptomatic deep venous thrombosis (DVT) (RR = 0.54; 95% CI: 0.28 to 1.05) asymptomatic DVT (RR = 0.81; 95% CI: 0.64 to 1.02), major bleeding (RR = 0.68; 95% CI: 0.10 to 4.78), thrombocytopenia (RR = 0.85; 95% CI: 0.49 to 1.46), or infection (RR = 0.91; 95% CI: 0.49 to 1.68). Similarly, low dose VKAs were not associated with a statistically significant effect on death (RR = 0.97; 95% CI: 0.82 to 1.15), symptomatic DVT (RR = 0.63; 95% CI: 0.35 to 1.11) or major bleeding (RR = 6.93; 95% CI: 0.86 to 56.08). However, they were associated with a statistically significant reduction in asymptomatic DVT (RR = 0.42; 95% CI: 0.28 to 0.61). Studies comparing heparin to VKA found no effects on any of the outcomes of interest.

Authors' conclusions:

We found no statistically significant effect of heparin or VKA on the outcomes of interest. However, the findings did not rule out clinically important benefits and harms. Patients with cancer with CVCs considering anticoagulation should balance the possible benefit of reduced thromboembolic complications with the possible harms and burden of anticoagulants.

This record should be cited as:

Akl EA, Vasireddi SRao, Gunukula S, Yosuico VE D, Barba M, Sperati F, Cook D, Schünemann H. Anticoagulation for patients with cancer and central venous catheters. Cochrane Database of Systematic Reviews 2011, Issue 4. Art. No.: CD006468. DOI: 10.1002/14651858.CD006468.pub4

Assessed as up to date:

January 13, 2011

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Primary Review Group:

Gynaecological Cancer Group

Health topics:

Cancer > Generic cancer care > Thrombo-embolism prevention & treatment

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Blood thinners to prevent blood clots in patients with cancer and central venous catheters

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