Abstract
Patients with cancer are at increased risk of recurrent venous thromboembolism (VTE) and bleeding. Thus, long-term treatment with anticoagulants for secondary prevention is challenging. The objective of this review was to evaluate current evidence on the safety and efficacy of tinzaparin compared with other anticoagulants for long-term VTE treatment in patients with cancer. Based on a preregistered protocol, we identified randomized controlled trials (RCTs) comparing long-term tinzaparin (therapeutic dose: 175 IU/kg) versus other anticoagulants for at least 3 months after an acute episode of VTE that included adult patients with underlying malignancy. We extracted predefined, clinically relevant outcomes of patients with cancer and, using standard methodology, pooled available data and assessed risk of bias and quality of evidence for each study. Three open-label RCTs evaluating 1169 patients with cancer were included in the analysis. Tinzaparin was associated with a significantly lower risk of recurrent VTE at the end of treatment (relative risk [RR], [95% confidence interval] 0.67 [0.46-0.99]) and at longest follow-up (RR: 0.58 [0.39-0.88]) and showed a lower risk of clinically relevant non-major bleeding at the end of treatment (RR: 0.71 [0.51-1.00]). No significant between-treatment differences were found for all-cause mortality (RR: 1.09 [0.91-1.30]) or fatal and non-fatal major bleeding events (RR: 1.06 [0.56-1.99]). The overall quality of evidence was deemed moderate, mainly due to small sample size in 2 of the studies and limited number of events in the meta-analyses. In conclusion, both short- and long-term treatments with tinzaparin were found to be superior to vitamin K antagonists for avoiding recurrences of VTE.
Highlights
Hemostasis and malignancy are strongly related,[1] and patients with cancer are at increased risk of venous thromboembolism (VTE).[2]
Included were randomized controlled trials (RCTs) evaluating non-selected adult patients, provided they included a well-defined subgroup of patients with cancer, and it was possible to identify the relevant outcomes for this subgroup of participants
This review found evidence of moderate quality suggesting that tinzaparin is associated with a risk reduction of all recurrent symptomatic VTE; and that tinzaparin and vitamin K antagonist therapy have a similar effect on all-cause mortality, Table 2
Summary
Hemostasis and malignancy are strongly related,[1] and patients with cancer are at increased risk of venous thromboembolism (VTE).[2] Venous thromboembolism occurs 4 times more often in patients with cancer compared with the general population.[3]. There is a wide variability related to the cancer type and time since diagnosis.[3] Multiple factors have been reported to increase the risk of venous thrombosis in patients with cancer. Some of these factors include chemotherapy, use of erythropoietin agents, and use of certain anticancer therapies such as thalidomide, high-dose steroids, and antiangiogenic therapy. The risk of VTE is higher in patients with coexisting chronic medical illnesses.[4]
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Schedule a callMore From: Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
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