Should patients undergoing treatment for cancer receive prophylaxis for thromboembolism?

Mandalà M,et al. Management of venous thromboembolism in cancer patients: ESMO clinical recommendations. Ann Oncol. 2008 May;19 Suppl 2:ii126-7.

Clinical guidelines managing VTE in cancer patients

Evidence cited are 4 RCTs from the meta-analysis below

Noble SI, et al. Management of venous thromboembolism in patients with advanced cancer: a systematic review and meta-analysis.  Lancet Oncol. 2008;9(6):577-84.
Error in Figure 2 – see corrected figure below.

Objective: Review anticoagulation treatment in patients with cancer, with particular focus on patients with advanced disease


  • Reproducible search of multiple medical databases, hand-searching of journals article reference lists.
  • Data extracted by 2 authors independently.
  • Only included studies with appropriate methodology and reporting anticoagulant treatment in patients with advanced cancer.

Useful Data
Corrected Fig. 2: Risk of developing recurrent venous thromboembolism with low- molecular-weight heparin compared with warfarin

  • Pooled (4 RCTs) RR=0.51, LMWH halves the risk compared to warfarin
  • Fig. 3: Risk of bleeding with low-molecular-weight heparin compared with warfarin  Pooled RR=1.10, no statistical difference

About Amy

Clinical Informationist at EUH Branch Library
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