Parenteral anticoagulation may prolong the survival of patients with limited small cell lung cancer: a Cochrane systematic review
Parenteral anticoagulation may prolong the survival of patients with limited small cell lung cancer: a Cochrane systematic review
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DOI：
10.1186/1756-9966-27-4
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发表时间：
2008-05-15
影响因子：
11.3
通讯作者：
Schuenemann, Holger J.
中科院分区：
文献类型：
--
作者：
Akl, Elie A.;van Doormaal, Frederiek F.;Schuenemann, Holger J.
背景资料：为了确定肝素（普通肝素（UFH）或低分子量肝素（LMWH））和磺达肝癸钠在改善癌症患者的生存率的有效性和安全性。方法：我们在2007年1月进行了全面的搜索相关的随机临床试验（RCT）。我们使用一个标准化的表格，一式两份地提取关于方法学质量、受试者、干预措施和关注结局（包括全因死亡率、血栓栓塞事件和出血事件）的数据。我们评估了每个结果的方法学质量分级的证据质量使用分级的建议评估，开发和评价（GRADE）methodologyResults：3986识别的引文，我们包括5个随机对照试验，没有评价磺达肝癸钠。生存率的证据质量为中等，大出血和小出血的证据质量较低，DVT的证据质量非常低。肝素治疗与具有统计学和临床意义的生存获益相关（风险比（HR）= 0.77; 95% CI = 0.65-0.91）。在亚组分析中，局限性小细胞肺癌患者经历了明显的生存获益（HR = 0.56; 95% CI = 0.38-0.83）。对于广泛性小细胞肺癌患者（HR = 0.80; 95% CI = 0.60-1.06）或晚期癌症患者（HR = 0.84; 95% CI = 0.68-1.03），生存获益均无统计学显著性。肝素出血风险增加无统计学意义（相对危险度（RR）= 1.78; 95%CI = 0.73-4.38）。结论：本综述表明肝素对癌症患者的生存有益，特别是对局限性小细胞肺癌患者。
Background: To determine the efficacy and safety of heparin (unfractionated heparin (UFH) or low-molecular-weight-heparin (LMWH)) and fondaparinux in improving the survival of patients with cancer.Methods: We conducted in January 2007 a comprehensive search for relevant randomized clinical trials (RCTs). We used a standardized form to extract in duplicate data on methodological quality, participants, interventions and outcomes of interest including all cause mortality, thromboembolic events, and bleeding events. We assessed the methodological quality for each outcome by grading the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodologyResults: Of 3986 identified citations, we included 5 RCTs, none of which evaluated fondaparinux. The quality of evidence was moderate for survival, low for major and minor bleeding, and very low for DVT. Heparin therapy was associated with a statistically and clinically significant survival benefit (hazard ratio (HR) = 0.77; 95% CI = 0.65-0.91). In subgroup analyses, patients with limited small cell lung cancer experienced a clear survival benefit (HR = 0.56; 95% CI = 0.38-0.83). The survival benefit was not statistically significant for either patients with extensive small cell lung cancer (HR = 0.80; 95% CI = 0.60-1.06) or patients with advanced cancer (HR = 0.84; 95% CI = 0.68-1.03). The increased risk of bleeding with heparin was not statistically significant (relative risk (RR) = 1.78; 95% CI = 0.73-4.38).Conclusion: This review suggests a survival benefit of heparin in cancer patients in general, and in patients with limited small cell lung cancer in particular.