The efficacy and safety of low-molecular-weight heparin use for cancer treatment: A meta-analysis

International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer

“…The sixth study 105 reported that patients were 65·0% more likely to experience a bleeding event with LMWH (7875 patients in the total population across the 11 studies; OR 1·65, 95% CI 1·12-2·44) compared with no prophylaxis (appendix p 46). The likelihood of bleeding on LMWH decreased when the analysis was limited to studies with a low risk of bias (41·0% compared with 65·0%), or when the analysis was limited to studies not limited to a single type of cancer (57·0% compared with 65·0%), and these odds ratios were not statistically signifi cant.. Three studies [106][107][108] of 855-6884 patients with cancer assessed bleeding with LMWH versus placebo or no intervention. All studies reported a signifi cant increase in minor bleeding in the LMWH prophylaxis group.…”

“…Overall, a signifi cant 45·0% reduction in VTE occurrence was reported across the six meta-analyses assessing the safety and effi cacy of LMWH compared with no intervention or placebo. [103][104][105][106]108,109 Specifi c cancer subgroup analyses across the meta-analyses showed that LMWH significantly reduced the VTE prevalence compared with no treatment or placebo by 67·9-71·2% in patients with pancreatic cancer (range of 430-748 patients) and by 50·3-53·6% in patients with lung cancer (range of 1926-2075 patients). 103,105 Five of six meta-analyses reported no signifi cant increase in major bleeding with LMWH (13·0-30·0% of patients received LMWH and had major bleeding) compared with no prophylaxis.…”

“…The updated search identifi ed eight meta-analyses (1669-9861 patients) [103][104][105][106][107][108][109][110] and six randomised clinical trials [111][112][113][114][115][116] comparing anticoagulant prophylaxis with no intervention or placebo in ambulatory patients receiving systemic anticancer therapy. Overall, a signifi cant 45·0% reduction in VTE occurrence was reported across the six meta-analyses assessing the safety and effi cacy of LMWH compared with no intervention or placebo.…”

Venous thromboembolism prophylaxis in cancer patients — guidelines focus on surgical patients

“…Meta-analysis performed by Che et al, brought similar conclusions in terms of efficacy of prophylaxis. The authors proved that pharmacological prophylaxis with low-molecular-heparin is beneficial, but at the same time increases the risk of bleeding complications in outpatients undergoing chemotherapy [289]. At this point, it must be mentioned, that the results of each of the published studies significantly differ with respect to the type and the stage of tumors, cancer treatment as well as the obtained results, that is to say the reduction of thromboembolic complications and the incidence of bleeding complications.…”

“…The analysis of the results of these studies showed that the prevention of VTE with prophylactic doses of low-molecular-weight heparin was beneficial for at least some outpatients receiving chemotherapy, but at the same time indicates that there is a potential risk of bleeding complications in this patient group [278,288,289]. These findings as well as the still limited number of studies on this issue promotes an individual approach to the treatment and individual assessment of benefits, as well as the risks of thromboprophylaxis in these patients.…”