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Anticoagulation for perioperative thromboprophylaxis in people with cancer.

ABSTRACT:

SUBMITTER: Matar CF

PROVIDER: S-EPMC6389341 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Anticoagulation for perioperative thromboprophylaxis in people with cancer.

Matar Charbel F CF Kahale Lara A LA Hakoum Maram B MB Tsolakian Ibrahim G IG Etxeandia-Ikobaltzeta Itziar I Yosuico Victor Ed VE Terrenato Irene I Sperati Francesca F Barba Maddalena M Schünemann Holger H Akl Elie A EA

The Cochrane database of systematic reviews 20180711

<h4>Background</h4>The choice of the appropriate perioperative thromboprophylaxis for people with cancer depends on the relative benefits and harms of different anticoagulants.<h4>Objectives</h4>To systematically review the evidence for the relative efficacy and safety of anticoagulants for perioperative thromboprophylaxis in people with cancer.<h4>Search methods</h4>This update of the systematic review was based on the findings of a comprehensive literature search conducted on 14 June 2018 that ...[more]

PMID: 29993117

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Project description:BackgroundIt is uncertain whether bridging anticoagulation is necessary for patients with atrial fibrillation who need an interruption in warfarin treatment for an elective operation or other elective invasive procedure. We hypothesized that forgoing bridging anticoagulation would be noninferior to bridging with low-molecular-weight heparin for the prevention of perioperative arterial thromboembolism and would be superior to bridging with respect to major bleeding.MethodsWe performed a randomized, double-blind, placebo-controlled trial in which, after perioperative interruption of warfarin therapy, patients were randomly assigned to receive bridging anticoagulation therapy with low-molecular-weight heparin (100 IU of dalteparin per kilogram of body weight) or matching placebo administered subcutaneously twice daily, from 3 days before the procedure until 24 hours before the procedure and then for 5 to 10 days after the procedure. Warfarin treatment was stopped 5 days before the procedure and was resumed within 24 hours after the procedure. Follow-up of patients continued for 30 days after the procedure. The primary outcomes were arterial thromboembolism (stroke, systemic embolism, or transient ischemic attack) and major bleeding.ResultsIn total, 1884 patients were enrolled, with 950 assigned to receive no bridging therapy and 934 assigned to receive bridging therapy. The incidence of arterial thromboembolism was 0.4% in the no-bridging group and 0.3% in the bridging group (risk difference, 0.1 percentage points; 95% confidence interval [CI], -0.6 to 0.8; P=0.01 for noninferiority). The incidence of major bleeding was 1.3% in the no-bridging group and 3.2% in the bridging group (relative risk, 0.41; 95% CI, 0.20 to 0.78; P=0.005 for superiority).ConclusionsIn patients with atrial fibrillation who had warfarin treatment interrupted for an elective operation or other elective invasive procedure, forgoing bridging anticoagulation was noninferior to perioperative bridging with low-molecular-weight heparin for the prevention of arterial thromboembolism and decreased the risk of major bleeding. (Funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health; BRIDGE ClinicalTrials.gov number, NCT00786474.).

Dataset Information

Anticoagulation for perioperative thromboprophylaxis in people with cancer.

Publications

Anticoagulation for perioperative thromboprophylaxis in people with cancer.

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