Author of

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  ORAL 16 - Clinical Care of Lung Cancer and Advanced Biopsies (ID 115)

  • Event: WCLC 2015
  • Type: Oral Session
  • Track: Treatment of Advanced Diseases - NSCLC
  • Presentations: 1
  • Moderators:J.W. Neal, Q. Zhou
  • Coordinates: 9/08/2015, 10:45 - 12:15, Mile High Ballroom 2a-3b

  • 14757

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    ORAL16.02 - Thromboembolic and Bleeding Risk with Adjuntctive LMWHs Anticoagulation in Lung Cancer Patients. Meta-Analysis of Randomized Trials (ID 2157)

    10:56 - 11:07  |  Author(s): J. Kowalewski
    • Abstract
    • Presentation
    • Slides

    Background:
    Venous thromboembolism (VTE) has been demonstrated one of the leading causes of mortality in lung cancer patients. While incidence of VTE in cancer patients varies from 4-20%, at autopsy VTE accounts for as high as 50%. Various strategies of VTE prophylaxis have been proposed, among them low-molecular weight heparins (LMWHs). While different randomized controlled trials (RCTs) showed benefit with LMWHs in regard to VTE, none single RCT was adequately powered for major bleeding. In a meta-analysis of RCTs we aimed to investigate the relation between thromboembolic and bleeding risk associated with LMWHs anticoagulation in lung cancer patients.
    
    Methods:
    Established methods were used in compliance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement in healthcare interventions. PubMed, EMBASE, CINAHL, Cochrane, Scopus databases as well as major congress proceedings until April 2015 were screened for RCTs comparing LMWHs with control/placebo. Outcomes assessed were VTE and major bleeding. Odds ratios (OR) and 95% confidence intervals were used as summary statistics. Data were analysed according to Intention-to-treat principle.
    
    Results:
    Four RCTs (N=3097) were included in the meta-analysis (Table 1). Average follow-up was 237 days. In a fixed effects model, LMWHs were associated with a significant 50% reduction of the odds of VTE as compared to controls: OR (95% CI): 0.50 (0.35-0.71); p<0.0001; I[2]=0%; (Figure 1A); the number needed to treat =33. A significant, over 2-fold increase in the odds of major bleeding was observed with LMWHs: OR (95% CI): 2.16 (1.16-4.05); p=0.02; I[2]=0%; (Figure 1B); the number needed to harm was 104.

    Table 1. Characteristics of included studies

    Study	N of pts	LMWH	Dose	NSCLC/SCLC	Follow-up (d)
    Agnelli et al. 2009	279	Nadroparin	3800 IU qd	79.9%-20.1%	112
    Altinbas et al. 1-2, 2004	84	Dalteparin	5000 IU qd	0%-100%	301
    Haas et al. 2012	546	Certoparin	3000 IU qd	100%-0%	168
    Woodruff et al. 2013	2202	Dalteparin	5000 IU qd	82.2%-18.8%	365

    Figure 1
    
    
    
    Conclusion:
    Low-molecular weight heparins significantly reduce the risk of venous thromboembolism at a price of increased major bleeding in patients with lung cancer. One episode of major bleeding occurred at every 3 VTEs prevented with LMWHs. Dose-escalation studies are certainly warranted to identify patients who would benefit most from LMWHs.
    
    

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