Key result
LMWH cuts recurrent VTE ~33% vs warfarin in cancer patients without excess bleeding or mortality.
Why the study?
Venous thromboembolism is frequent and predicts poor outcomes in cancer patients, with higher recurrence rates, making comparisons between LMWH and warfarin essential for healthcare decisions.
Does low-molecular-weight heparin reduce recurrent VTE compared to warfarin in adult cancer patients?
Systematic Review (n=2,081)
Does low-molecular-weight heparin reduce recurrent VTE compared to warfarin in adult cancer patients?
In adult cancer patients, low-molecular-weight heparin significantly reduces the risk of recurrent VTE compared to warfarin without increasing the risk of bleeding or mortality.
LMWH should be preferred over warfarin for secondary VTE prevention in cancer patients; confirms and strengthens meta-analytic support for current guidelines.
Venous thromboembolism (VTE) is a condition often seen in patients diagnosed with cancer and is recognized as a predictor of poor outcomes in these patients. The probability of VTE recurring is generally higher in people with cancer than in those without; hence, addressing this issue is essential when making healthcare decisions. Therefore, our systematic review was primarily designed to compare low-weight- molecular heparin (LMWH) to warfarin in reducing recurrent VTE among cancer patients. However, other outcomes were also evaluated, such as mortality and bleeding events observed more in cancer patients. The selection of relevant articles was carried out using a database search and a manual search, which involved reviewing reference lists of articles eligible for inclusion in the current review. The methodological quality of each included study was then assessed using Cochrane's risk of bias tool in the Review Manager software (RevMan 5.4.1). Additionally, pooled results were examined using the Review Manager software and presented as forest plots. Our search of electronic databases elicited a total of 2163 articles, of which only six were deemed eligible for inclusion and analysis. Data pooled from the six studies demonstrated the effectiveness of LMWH in minimizing the reoccurrence of VTE over warfarin [risk ratio (RR): 0.67; 95% CI: 0.47 - 0.95; p = 0.03]. However, LMWH had a similar effect statistically as warfarin on the major bleeding events (RR: 1.05; 95% CI: 0.62 - 1.77; p = 0.85), minor bleeding events (RR: 0.80; 95% CI: 0.54 - 1.20; p = 0.28), and all-cause mortality (RR: 1.00; 95% CI: 0.88 - 1.13; p = 0.99). While LMWH demonstrated its effectiveness in minimizing the incidence of VTE recurrence over warfarin in cancer patients, it had no statistical difference in terms of mortality or bleeding events when compared to warfarin. Based on our findings, we recommend that LMWH continues to be used as a first-line treatment regimen to mitigate recurrent VTE in cancer patients.
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Zaki et al. (2023) conducted a systematic review in Cancer-associated thrombosis (n=2,081). Low-Molecular-Weight Heparin (LMWH) vs. Warfarin was evaluated on Recurrent venous thromboembolism (VTE) (RR 0.67, 95% CI 0.47 - 0.95, p=0.03). Low-molecular-weight heparin significantly reduced the risk of recurrent venous thromboembolism compared to warfarin in adult cancer patients (RR 0.67), with no significant difference in bleeding or mortality.
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