Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Cochrane on Anticoagulants in Patients with Cancer

Cochrane; 2017 Sep 11; Akl, Kahale, Hakoum, et al

Heparin reduces venous thromboembolism in people with cancer, but it also increases bleeding risk and does not appear to improve mortality at 1 and 2 years, according to a Cochrane review of 19 trials involving more than 9,600 individuals. Most participants had small cell lung cancer, non-small cell lung cancer, or pancreatic cancer. Among the reviewers’ conclusions:

  • Injectable blood thinners reduce the risk of blood clots by about half (high quality evidence).
  • They likely increase the risk of major bleeding by 4 more/1,000 and minor bleeding by 17 more/1,000 (moderate quality evidence).
  • Their impact on survival is uncertain, but likely very small (moderate quality evidence).
  • Quality of life impact is uncertain (moderate quality evidence).

The authors noted that given the mixed results, clinicians should seek patient input about values and preferences before using blood thinners.

Citation:

Akl E, Kahale L, Hakoum M, et al. Parenteral anticoagulation in ambulatory patients with cancer. Cochrane Database of Syst Rev. 2017, Issue 9. Art. No.: CD006652. doi:10.1002/14651858.CD006652.pub5.

This Week's Must Reads

Tamibarotene vs. ATRA in APL, Source: Takeshita A et al. ASH 2017, abstract 642.

HIT Incidence During Obstetric Hospital Admissions, Am J Perinatol.; ePub 2018 Feb 8; Sagaram, et al

Endoscopy for GI Bleeds in Severe Thrombocytopenia, Gastrointest Endosc; ePub 2018 Feb 1; Ramos, et al

Does This Predict Acute Pain in Children with SCD? , Am J Hematol; ePub 2018 Jan 25; Willen, et al

Ibuprofen Use in Alcohol-Related Thrombocytopenia , Hosp Pharm; 2018 Feb; Muhammad, Tomko, et al

Must Reads in Bleeding Disorders

HIT Incidence During Obstetric Hospital Admissions, Am J Perinatol.; ePub 2018 Feb 8; Sagaram, et al

Endoscopy for GI Bleeds in Severe Thrombocytopenia, Gastrointest Endosc; ePub 2018 Feb 1; Ramos, et al

Does This Predict Acute Pain in Children with SCD? , Am J Hematol; ePub 2018 Jan 25; Willen, et al

Ibuprofen Use in Alcohol-Related Thrombocytopenia , Hosp Pharm; 2018 Feb; Muhammad, Tomko, et al

Romiplostim-Treated Patients: No Increased AML Risk, Lancet Haematol; ePub 2018 Jan 25; Kantarjian, et al