Joshua Montroy1, Manoj M Lalu1,2,3, Rebecca C Auer4,5, Emma Grigor1,6, Sasha Mazzarello1, Marc Carrier1,6, Jonathan Kimmelman7, Dean A Fergusson2,4. 1. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. 2. Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada. 3. Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. 4. Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. 5. Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada. 6. Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. 7. Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada.
Abstract
BACKGROUND: Low molecular weight heparins (LMWH) are often used as a first-line therapy for the prevention of thrombosis in cancer patients. Preclinical evidence from animal models suggests that LMWH may have antimetastatic properties. Clinical evidence of this effect is inconclusive. The objective of this systematic review is to evaluate the effect of LMWH on overall survival in patients with solid tumor malignancies. METHODS: MEDLINE, Embase, and The Cochrane Central Register of Controlled trials were searched from inception to November 26, 2018. We included randomized controlled trials that compared LMWH to placebo, a no-treatment arm, or a short-term prophylactic course of LMWH in adult patients with solid tumors. The primary outcome was overall survival. Secondary outcomes included progression-free survival, the occurrence of venous thromboembolism, and major bleeding events. The risk of bias was assessed in duplicate using the Cochrane Risk-of-Bias tool. RESULTS: Forty-five articles were included in the review. Overall, no difference in overall survival was observed between groups (risk ratio: 1.00; 95% confidence interval: 0.98-1.02; I2 = 36.5%). In our a priori defined subgroup analyses, the effect was not shown to vary by the type of LMWH, duration of LMWH use, length of study follow-up, comparator used in the study, or the setting in which the LMWH was administered. The majority of studies had an unclear risk of bias for at least one methodological criterion. CONCLUSION: Although LMWH is thought to possess antimetastatic properties and thus have the potential to improve survival in cancer patients, existing data do not support this hypothesis. Georg Thieme Verlag KG Stuttgart · New York.
BACKGROUND:Low molecular weight heparins (LMWH) are often used as a first-line therapy for the prevention of thrombosis in cancerpatients. Preclinical evidence from animal models suggests that LMWH may have antimetastatic properties. Clinical evidence of this effect is inconclusive. The objective of this systematic review is to evaluate the effect of LMWH on overall survival in patients with solid tumor malignancies. METHODS: MEDLINE, Embase, and The Cochrane Central Register of Controlled trials were searched from inception to November 26, 2018. We included randomized controlled trials that compared LMWH to placebo, a no-treatment arm, or a short-term prophylactic course of LMWH in adult patients with solid tumors. The primary outcome was overall survival. Secondary outcomes included progression-free survival, the occurrence of venous thromboembolism, and major bleeding events. The risk of bias was assessed in duplicate using the Cochrane Risk-of-Bias tool. RESULTS: Forty-five articles were included in the review. Overall, no difference in overall survival was observed between groups (risk ratio: 1.00; 95% confidence interval: 0.98-1.02; I2 = 36.5%). In our a priori defined subgroup analyses, the effect was not shown to vary by the type of LMWH, duration of LMWH use, length of study follow-up, comparator used in the study, or the setting in which the LMWH was administered. The majority of studies had an unclear risk of bias for at least one methodological criterion. CONCLUSION: Although LMWH is thought to possess antimetastatic properties and thus have the potential to improve survival in cancerpatients, existing data do not support this hypothesis. Georg Thieme Verlag KG Stuttgart · New York.
Authors: Rebecca C Auer; Michael Ott; Paul Karanicolas; Muriel Rebecca Brackstone; Shady Ashamalla; Joel Weaver; Vicky Tagalakis; Marylise Boutros; Peter Stotland; Antonio Caycedo Marulanda; Husein Moloo; Shiva Jayaraman; Suni Patel; Grégoire Le Gal; Silvana Spadafora; Steven MacLellan; Daniel Trottier; Derek Jonker; Timothy Asmis; Ranjeeta Mallick; Amanda Pecarskie; Tim Ramsay; Marc Carrier Journal: BMJ Date: 2022-09-13
Authors: Heide-Marie Binder; Nicole Maeding; Martin Wolf; André Cronemberger Andrade; Balazs Vari; Linda Krisch; Fausto Gueths Gomes; Constantin Blöchl; Katharina Muigg; Rodolphe Poupardin; Anna M Raninger; Thomas Heuser; Astrid Obermayer; Patricia Ebner-Peking; Lisa Pleyer; Richard Greil; Christian G Huber; Katharina Schallmoser; Dirk Strunk Journal: Cells Date: 2021-11-26 Impact factor: 6.600