Once daily versus twice daily enoxaparin for acute pulmonary embolism in cancer patients

King, Amber C.; Maggie, Q.; Chisholm, Gary B.; Toale, Katy M.

doi:10.1177/1078155215583374

Cited by 5 publications

(19 citation statements)

References 10 publications

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“…In one study, patients were not randomized to once-daily or twice-daily enoxaparin for the initial treatment of VTE (20), while in four trials, LMWHs other than enoxaparin were used (16)(17)(18)(19). A total of six studies were finally included in the review (9,10,(21)(22)(23)(24). In one study (21), outcome data were not extractable and e-mails to the corresponding author did not elicit a response.…”

Section: Resultsmentioning

confidence: 99%

“…One study was an RCT (22) and two were prospective studies with historic control groups (10,23), while the remaining studies were retrospective studies (9,21,24). A total of two studies were performed specifically on cancer patients (9,24). VTE was confirmed by imaging in all studies.…”

Section: Resultsmentioning

confidence: 99%

“…The enoxaparin dose was 1.5 mg/kg in the once-daily group and 1 mg/kg in the twice-daily group in all studies. The duration of enoxaparin treatment was not reported in four studies (9,21,23,24). In three studies (10,22,23), enoxaparin was used as bridging therapy to oral anti-coagulants.…”

Section: Resultsmentioning

confidence: 99%

“…Despite anti-coagulant therapy, cancer patients have a three-fold risk of developing recurrent VTE as compared to patients without malignancy (29). In addition, the risk of hemorrhagic complications is higher when cancer patients receive anti-coagulation therapy (24,27). In the present review, the studies of King et al (24) and Fuller et al (9) were specifically performed on cancer patients.…”

Section: Discussionmentioning

confidence: 96%

“…The included RCT (20) was of high quality with low risk of bias in all domains. For non-RCTs, only one study (24) had low risk of bias for selection of participants. None of the studies took into account confounding factors or had blinded outcome assessment.…”

Section: Sample Sizementioning

confidence: 99%

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Once‑daily vs. twice‑daily dosing of enoxaparin for the management of venous thromboembolism: A systematic review and meta‑analysis

Niu

Song

et al. 2020

Exp Ther Med

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The present study aimed to determine whether there is any difference in the efficacy and safety of once-daily vs. twice-daily enoxaparin when used for the initial treatment of venous thromboembolism (VTE). The PubMed, Embase, Cochrane Central Register of Controlled Trials, Science Direct and Google Scholar databases were searched for studies comparing once-daily and twice-daily enoxaparin for the initial treatment of VTE added from inception up to 1st October 2019. Studies utilizing any other low-molecular-weight heparin and using enoxaparin for VTE prophylaxis were excluded. A total of 6 studies were included in the systematic review and 5 in the meta-analysis. Only one study was a randomized controlled trial (RCT). Pooled analysis of 460 patients receiving once-daily enoxaparin and 464 patients receiving twice-daily enoxaparin indicated no significant difference between the two dosing regimens regarding VTE recurrence [odds ratio (OR)=1.48, 95%CI: 0.75-2.89, P=0.26; I 2 = 0%]. No significant difference in major hemorrhagic complications was noted (OR=1.21, 95%CI: 0.52-2.81, P=0.66; I 2 = 0%). Subgroup analysis based on study type and use of enoxaparin for bridging therapy did not change the overall results. In cancer patients, no statistically significant difference in the recurrence of VTE was obtained between once-daily and twice-daily enoxaparin, but the confidence intervals were wide with a tendency to favor twice-daily dosing (OR=2.28, 95%CI: 0.91-5.75, P= 0.08; I 2 = 0%). The overall quality of the studies was determined to be average. To conclude, while the present results suggested no significant difference in efficacy and safety of once-daily vs. twice-daily enoxaparin when used for the initial treatment of VTE, the quality of the evidence may not have been sufficiently high to support the conclusions with confidence. Further high-quality and adequately powered RCTs are required to corroborate the present results.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 96%

Section: Sample Sizementioning

confidence: 99%

See 3 more Smart Citations

Once‑daily vs. twice‑daily dosing of enoxaparin for the management of venous thromboembolism: A systematic review and meta‑analysis

Niu

Song

et al. 2020

Exp Ther Med

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Structured benefit–risk assessment for enoxaparin, in the context of its label extension, for the extended treatment of deep vein thrombosis and pulmonary embolism, and prevention of its recurrence in patients with active cancer

Kürzinger,

El‐Haddad,

Gouin‐Soboleva

et al. 2024

Pharmacoepidemiology and Drug

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PurposeGuidelines recommend low‐molecular‐weight heparins (LMWHs) for patients with cancer‐associated thrombosis. However, until recently, only dalteparin and tinzaparin were approved in the European Economic Area (EEA) for these patients. This study compares the benefit–risk profile of enoxaparin with dalteparin and tinzaparin for the extended treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrence in adult patients with active cancer.MethodsA semi‐quantitative structured benefit–risk assessment was conducted for the label‐extension application of enoxaparin based on the benefit–risk action team descriptive framework: define decision context; determine key benefit and risk outcomes; identify data sources; extract data; interpret results.ResultsThe key benefits were defined as reduced all‐cause mortality and venous thromboembolism (VTE) recurrence (including symptomatic DVT, fatal PE or non‐fatal PE); the key risks were major and non‐major bleeding of clinical significance, and heparin‐induced thrombocytopenia (HIT). Enoxaparin demonstrated comparable effects for the reduction of VTE recurrence and all‐cause mortality versus other EEA‐approved LMWHs (dalteparin, tinzaparin). There was no evidence of a significant difference between enoxaparin and the comparator groups with regard to incidence of major and non‐major bleeding. The data on HIT were too limited to assess the difference between the two groups.ConclusionsThe assessment demonstrated a favourable benefit–risk profile for enoxaparin similar to that of other EEA‐approved LMWHs for the treatment of DVT and PE and the prevention of recurrence in patients with active cancer and thus supported the label‐extension approval.

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Herz-Kreislauf-System

2022

Arzneimitteltherapie in Der Palliativmedizin

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Once daily versus twice daily enoxaparin for acute pulmonary embolism in cancer patients

Abstract: Cancer patients receiving once daily enoxaparin for the treatment of acute PE may be at increased risk of recurrent PE and clinically overt bleeding. Larger randomized trials are needed to confirm the results of this study.

Cited by 5 publications

References 10 publications

Once‑daily vs. twice‑daily dosing of enoxaparin for the management of venous thromboembolism: A systematic review and meta‑analysis

Once‑daily vs. twice‑daily dosing of enoxaparin for the management of venous thromboembolism: A systematic review and meta‑analysis

Structured benefit–risk assessment for enoxaparin, in the context of its label extension, for the extended treatment of deep vein thrombosis and pulmonary embolism, and prevention of its recurrence in patients with active cancer

Herz-Kreislauf-System

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