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Anticoagulation management and related outcomes in patients with cancer-associated thrombosis and thrombocytopenia: A systematic review and meta-analysis
Patients with cancer have an increased risk of both venous thromboembolism (VTE) requiring anticoagulation and thrombocytopenia. The optimal management is unclear. We performed a systematic review and meta-analysis to evaluate the outcomes in these patients. We searched MEDLINE, Embase, Scopus, and...
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| Published in: | Thrombosis research 2023-07, Vol.227, p.8-16 |
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| cites | cdi_FETCH-LOGICAL-c368t-9953bfee694635342a68716cfbff4a1685cc957244f37863a0cf0176820167713 |
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| container_title | Thrombosis research |
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| creator | Wang, Tzu-Fei Carrier, Marc Carney, Brian J. Kimpton, Miriam Delluc, Aurélien |
| description | Patients with cancer have an increased risk of both venous thromboembolism (VTE) requiring anticoagulation and thrombocytopenia. The optimal management is unclear. We performed a systematic review and meta-analysis to evaluate the outcomes in these patients.
We searched MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials from inception to February 5, 2022. Studies assessing adult patients with cancer-associated thrombosis and platelet count |
| doi_str_mv | 10.1016/j.thromres.2023.05.012 |
| format | article |
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We searched MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials from inception to February 5, 2022. Studies assessing adult patients with cancer-associated thrombosis and platelet count <100 × 109/L were included. Three anticoagulation management strategies were reported: full dose, modified dose, or no anticoagulation. The primary efficacy outcome was recurrent VTE, and the primary safety outcome was major bleeding. The incidence rates of thrombotic and bleeding outcomes by anticoagulation management strategies were descriptive, and were pooled using random effects model and expressed as events per 100 patient-months with associated 95 % confidence intervals (CI).
We included 19 observational cohort studies (N = 1728 patients) in the systematic review, with 10 included in the meta-analysis (N = 707 patients). Approximately 90 % of patients had hematological malignancies, with low-molecular-weight heparin being the main anticoagulant. The rates of recurrent VTE and bleeding complications were high regardless of management strategies – recurrent VTE on full dose: 2.65/100 patient-months (95 % CI 1.62–4.32), modified dose: 3.51/100 patient-months (95 % CI 1.00–12.39); major bleeding on full dose: 4.45/100 patient-months (95 % CI 2.80–7.06), modified dose: 4.16/100 patient-months (95 % CI 2.24–7.74). There was serious risk of bias in all studies.
Patients with cancer-associated thrombosis and thrombocytopenia have high risks of both recurrent VTE and major bleeding, but current literature is significantly limited to guide the best management.
•Patients with cancer have increased risks of thrombocytopenia and venous thrombosis.•Anticoagulation management in these patients is challenging.•We performed a systematic review and meta-analysis in this patient population.•High rates of both recurrent thrombosis and bleeding events were found.•There are severe limitations in the current data to conclude the best management.</description><identifier>ISSN: 0049-3848</identifier><identifier>EISSN: 1879-2472</identifier><identifier>DOI: 10.1016/j.thromres.2023.05.012</identifier><identifier>PMID: 37196605</identifier><language>eng</language><publisher>United States: Elsevier Ltd</publisher><subject>Adult ; Anticoagulants - adverse effects ; Anticoagulation ; cancer-associated thrombosis ; Hemorrhage - chemically induced ; Heparin, Low-Molecular-Weight - therapeutic use ; Humans ; Malignancy ; meta-analysis ; Neoplasm Recurrence, Local - chemically induced ; Neoplasm Recurrence, Local - complications ; Systematic review ; Thrombocytopenia ; Thrombocytopenia - chemically induced ; Thrombocytopenia - complications ; Thrombocytopenia - drug therapy ; Thrombosis - chemically induced ; Thrombosis - etiology ; Venous Thromboembolism - chemically induced ; Venous Thromboembolism - etiology</subject><ispartof>Thrombosis research, 2023-07, Vol.227, p.8-16</ispartof><rights>2023 Elsevier Ltd</rights><rights>Copyright © 2023 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-9953bfee694635342a68716cfbff4a1685cc957244f37863a0cf0176820167713</citedby><cites>FETCH-LOGICAL-c368t-9953bfee694635342a68716cfbff4a1685cc957244f37863a0cf0176820167713</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37196605$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wang, Tzu-Fei</creatorcontrib><creatorcontrib>Carrier, Marc</creatorcontrib><creatorcontrib>Carney, Brian J.</creatorcontrib><creatorcontrib>Kimpton, Miriam</creatorcontrib><creatorcontrib>Delluc, Aurélien</creatorcontrib><title>Anticoagulation management and related outcomes in patients with cancer-associated thrombosis and thrombocytopenia: A systematic review and meta-analysis</title><title>Thrombosis research</title><addtitle>Thromb Res</addtitle><description>Patients with cancer have an increased risk of both venous thromboembolism (VTE) requiring anticoagulation and thrombocytopenia. The optimal management is unclear. We performed a systematic review and meta-analysis to evaluate the outcomes in these patients.
We searched MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials from inception to February 5, 2022. Studies assessing adult patients with cancer-associated thrombosis and platelet count <100 × 109/L were included. Three anticoagulation management strategies were reported: full dose, modified dose, or no anticoagulation. The primary efficacy outcome was recurrent VTE, and the primary safety outcome was major bleeding. The incidence rates of thrombotic and bleeding outcomes by anticoagulation management strategies were descriptive, and were pooled using random effects model and expressed as events per 100 patient-months with associated 95 % confidence intervals (CI).
We included 19 observational cohort studies (N = 1728 patients) in the systematic review, with 10 included in the meta-analysis (N = 707 patients). Approximately 90 % of patients had hematological malignancies, with low-molecular-weight heparin being the main anticoagulant. The rates of recurrent VTE and bleeding complications were high regardless of management strategies – recurrent VTE on full dose: 2.65/100 patient-months (95 % CI 1.62–4.32), modified dose: 3.51/100 patient-months (95 % CI 1.00–12.39); major bleeding on full dose: 4.45/100 patient-months (95 % CI 2.80–7.06), modified dose: 4.16/100 patient-months (95 % CI 2.24–7.74). There was serious risk of bias in all studies.
Patients with cancer-associated thrombosis and thrombocytopenia have high risks of both recurrent VTE and major bleeding, but current literature is significantly limited to guide the best management.
•Patients with cancer have increased risks of thrombocytopenia and venous thrombosis.•Anticoagulation management in these patients is challenging.•We performed a systematic review and meta-analysis in this patient population.•High rates of both recurrent thrombosis and bleeding events were found.•There are severe limitations in the current data to conclude the best management.</description><subject>Adult</subject><subject>Anticoagulants - adverse effects</subject><subject>Anticoagulation</subject><subject>cancer-associated thrombosis</subject><subject>Hemorrhage - chemically induced</subject><subject>Heparin, Low-Molecular-Weight - therapeutic use</subject><subject>Humans</subject><subject>Malignancy</subject><subject>meta-analysis</subject><subject>Neoplasm Recurrence, Local - chemically induced</subject><subject>Neoplasm Recurrence, Local - complications</subject><subject>Systematic review</subject><subject>Thrombocytopenia</subject><subject>Thrombocytopenia - chemically induced</subject><subject>Thrombocytopenia - complications</subject><subject>Thrombocytopenia - drug therapy</subject><subject>Thrombosis - chemically induced</subject><subject>Thrombosis - etiology</subject><subject>Venous Thromboembolism - chemically induced</subject><subject>Venous Thromboembolism - etiology</subject><issn>0049-3848</issn><issn>1879-2472</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNqFkc1u3CAUhVHVqJmmfYWIZTd2-DfuqqMoaStF6iZdIwZfJ4xsmAJuNI-Stw2ZmXTbFQK-ew6cg9AlJS0lVF1t2_KY4pwgt4ww3hLZEsreoRXVXd8w0bH3aEWI6BuuhT5HH3PeEkI72ssP6JzXVSkiV-h5HYp30T4sky0-BjzbYB9ghlCwDQNOUM9hwHEpLs6QsQ94V8l6n_GTL4_Y2eAgNTbn6PyBPbxsE7PPB4nT1u1L3EHw9ite47zPBeaq46rDXw9PB3KGYpvqP-3r7Cd0Ntopw-fTeoF-397cX_9o7n59_3m9vmscV7o0fS_5ZgRQvVBccsGs0h1VbtyMo7BUaelcLzsmxMg7rbglbqw5KM1qjF1H-QX6ctTdpfhngVzM7LODabIB4pIN01Syqk1ERdURdSnmnGA0u-Rnm_aGEvNai9mat1rMay2GSFNrqYOXJ49lM8Pwb-ythwp8OwJQf1rzSCa7mrGDwSdwxQzR_8_jBU8rpbI</recordid><startdate>202307</startdate><enddate>202307</enddate><creator>Wang, Tzu-Fei</creator><creator>Carrier, Marc</creator><creator>Carney, Brian J.</creator><creator>Kimpton, Miriam</creator><creator>Delluc, Aurélien</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202307</creationdate><title>Anticoagulation management and related outcomes in patients with cancer-associated thrombosis and thrombocytopenia: A systematic review and meta-analysis</title><author>Wang, Tzu-Fei ; Carrier, Marc ; Carney, Brian J. ; Kimpton, Miriam ; Delluc, Aurélien</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-9953bfee694635342a68716cfbff4a1685cc957244f37863a0cf0176820167713</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Anticoagulants - adverse effects</topic><topic>Anticoagulation</topic><topic>cancer-associated thrombosis</topic><topic>Hemorrhage - chemically induced</topic><topic>Heparin, Low-Molecular-Weight - therapeutic use</topic><topic>Humans</topic><topic>Malignancy</topic><topic>meta-analysis</topic><topic>Neoplasm Recurrence, Local - chemically induced</topic><topic>Neoplasm Recurrence, Local - complications</topic><topic>Systematic review</topic><topic>Thrombocytopenia</topic><topic>Thrombocytopenia - chemically induced</topic><topic>Thrombocytopenia - complications</topic><topic>Thrombocytopenia - drug therapy</topic><topic>Thrombosis - chemically induced</topic><topic>Thrombosis - etiology</topic><topic>Venous Thromboembolism - chemically induced</topic><topic>Venous Thromboembolism - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wang, Tzu-Fei</creatorcontrib><creatorcontrib>Carrier, Marc</creatorcontrib><creatorcontrib>Carney, Brian J.</creatorcontrib><creatorcontrib>Kimpton, Miriam</creatorcontrib><creatorcontrib>Delluc, Aurélien</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Thrombosis research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wang, Tzu-Fei</au><au>Carrier, Marc</au><au>Carney, Brian J.</au><au>Kimpton, Miriam</au><au>Delluc, Aurélien</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Anticoagulation management and related outcomes in patients with cancer-associated thrombosis and thrombocytopenia: A systematic review and meta-analysis</atitle><jtitle>Thrombosis research</jtitle><addtitle>Thromb Res</addtitle><date>2023-07</date><risdate>2023</risdate><volume>227</volume><spage>8</spage><epage>16</epage><pages>8-16</pages><issn>0049-3848</issn><eissn>1879-2472</eissn><abstract>Patients with cancer have an increased risk of both venous thromboembolism (VTE) requiring anticoagulation and thrombocytopenia. The optimal management is unclear. We performed a systematic review and meta-analysis to evaluate the outcomes in these patients.
We searched MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials from inception to February 5, 2022. Studies assessing adult patients with cancer-associated thrombosis and platelet count <100 × 109/L were included. Three anticoagulation management strategies were reported: full dose, modified dose, or no anticoagulation. The primary efficacy outcome was recurrent VTE, and the primary safety outcome was major bleeding. The incidence rates of thrombotic and bleeding outcomes by anticoagulation management strategies were descriptive, and were pooled using random effects model and expressed as events per 100 patient-months with associated 95 % confidence intervals (CI).
We included 19 observational cohort studies (N = 1728 patients) in the systematic review, with 10 included in the meta-analysis (N = 707 patients). Approximately 90 % of patients had hematological malignancies, with low-molecular-weight heparin being the main anticoagulant. The rates of recurrent VTE and bleeding complications were high regardless of management strategies – recurrent VTE on full dose: 2.65/100 patient-months (95 % CI 1.62–4.32), modified dose: 3.51/100 patient-months (95 % CI 1.00–12.39); major bleeding on full dose: 4.45/100 patient-months (95 % CI 2.80–7.06), modified dose: 4.16/100 patient-months (95 % CI 2.24–7.74). There was serious risk of bias in all studies.
Patients with cancer-associated thrombosis and thrombocytopenia have high risks of both recurrent VTE and major bleeding, but current literature is significantly limited to guide the best management.
•Patients with cancer have increased risks of thrombocytopenia and venous thrombosis.•Anticoagulation management in these patients is challenging.•We performed a systematic review and meta-analysis in this patient population.•High rates of both recurrent thrombosis and bleeding events were found.•There are severe limitations in the current data to conclude the best management.</abstract><cop>United States</cop><pub>Elsevier Ltd</pub><pmid>37196605</pmid><doi>10.1016/j.thromres.2023.05.012</doi><tpages>9</tpages></addata></record> |
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| subjects | Adult Anticoagulants - adverse effects Anticoagulation cancer-associated thrombosis Hemorrhage - chemically induced Heparin, Low-Molecular-Weight - therapeutic use Humans Malignancy meta-analysis Neoplasm Recurrence, Local - chemically induced Neoplasm Recurrence, Local - complications Systematic review Thrombocytopenia Thrombocytopenia - chemically induced Thrombocytopenia - complications Thrombocytopenia - drug therapy Thrombosis - chemically induced Thrombosis - etiology Venous Thromboembolism - chemically induced Venous Thromboembolism - etiology |
| title | Anticoagulation management and related outcomes in patients with cancer-associated thrombosis and thrombocytopenia: A systematic review and meta-analysis |
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