January 1, 2006British Journal of CancerOpen Access

Primary thromboprophylaxis for cancer patients with central venous catheters – a reappraisal of the evidence

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Cancer with central venous catheters (n=1932). Intervention: Primary thromboprophylaxis (minidose warfarin or LMWH) vs. No prophylaxis or placebo. Primary outcome: Incidence of asymptomatic and/or symptomatic DVT, PE, and overall mortality.

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Key result

Routine primary thromboprophylaxis with minidose warfarin or low-molecular-weight heparin has no proven role in preventing central venous catheter-related thrombosis in cancer patients.

Why the study?

Does primary thromboprophylaxis (warfarin or heparin) reduce the incidence of venous thromboembolism in adult cancer patients with central venous catheters?

Population

Adult cancer patients receiving a central venous catheter across 9 prospective studies.

Comparison

Primary thromboprophylaxis with minidose… vs Placebo or no thromboprophylaxis.

Design

Systematic_review

Authors

MCMoya CunninghamSt. Luke's Hospital BWB. WhiteMater Misericordiae University Hospital DHDonal HollywoodTrinity College Dublin

Discussion

Member takes

Implication

Supports withholding routine thromboprophylaxis in cancer patients with CVCs; confirms lack of efficacy from high-quality trials.

Study Design

Type

Systematic Review (n=1,932)

Structured PICO

Does primary thromboprophylaxis (warfarin or heparin) reduce the incidence of venous thromboembolism in adult cancer patients with central venous catheters?

Population

A systematic review of 9 prospective studies including 1,932 adult cancer patients with central venous catheters evaluating the efficacy of primary thromboprophylaxis.

Intervention

Primary thromboprophylaxis with minidose warfarin (1 mg daily), low molecular weight heparin (LMWH), or unfractionated heparin.

Comparator

Placebo or no thromboprophylaxis.

Outcome

Incidence of asymptomatic and/or symptomatic DVT, PE, and overall mortality.hard clinical

Routine primary thromboprophylaxis with minidose warfarin or LMWH is not recommended for cancer patients with central venous catheters due to a lack of proven efficacy in high-quality placebo-controlled trials.

Limitations

Small cohort sizes in most included studies
Discrepant patient populations including various tumor types and stages
Critical differences in study design, such as symptomatic versus asymptomatic endpoints
Significant minority of patients unable to complete their assigned period of thromboprophylaxis
Lack of stratification for important confounding factors
Small cohort sizes
Discrepant populations of patients (different tumour types and stages)
Critical differences in study design (symptomatic vs asymptomatic endpoints)
Significant minority of patients unable to complete assigned period of thromboprophylaxis

Cite This Study

Cunningham et al. (2006) conducted a systematic review in Cancer with central venous catheters (n=1,932). Primary thromboprophylaxis (minidose warfarin or LMWH) vs. No prophylaxis or placebo was evaluated on Incidence of asymptomatic and/or symptomatic DVT, PE, and overall mortality. Routine primary thromboprophylaxis with minidose warfarin or low-molecular-weight heparin has no proven role in preventing central venous catheter-related thrombosis in cancer patients.

synapsesocial.com/papers/6a20836623a8c2fe81f89437 https://doi.org/10.1038/sj.bjc.6602917

Topics

Anticoagulation in AF

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Primary thromboprophylaxis for cancer patients with central venous catheters – a reappraisal of the evidence

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

Topics

Primary thromboprophylaxis for cancer patients with central venous catheters – a reappraisal of the evidence

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

Also Consider