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

Widespread Zika screens not cost effective, Saá P et al. New Engl J Med. 2018;378:1778-88. doi: 10.1056/NEJMoa1714977

New cancer drugs linked to fewer arrhythmias, Nickel A et al. annual meeting of the American College of Cardiology ACC 18, Abstract #900-06.

Good ALL outcomes in Down syndrome children, Maloney K et al. ASPHO 2018, annual meeting of the American Society of Pediatric Hematology/Oncology Abstract PP 2001

Reducing morbidity in postpartum hemorrhage, Smith R et al. Annual clinical and scientific meeting of the American Society of Obstetricians and Gynecologists 2018, Abstract 26R.

In sickle cell, start hydroxyurea in infancy, Schuchard S et al. ASPHO 2018, poster # 342 Schuchard S et al. ASPHO 2018, poster # 342. https://onlinelibrary.wiley.com/doi/10.1002/pbc.27057

Must Reads in Bleeding Disorders

Reducing morbidity in postpartum hemorrhage, Smith R et al. Annual clinical and scientific meeting of the American Society of Obstetricians and Gynecologists 2018, Abstract 26R.

In sickle cell, start hydroxyurea in infancy, Schuchard S et al. ASPHO 2018, poster # 342 Schuchard S et al. ASPHO 2018, poster # 342. https://onlinelibrary.wiley.com/doi/10.1002/pbc.27057

Increase kidney function monitoring if INR exceeds 4.0, Traquair H et al. biennial summit of the Thrombosis & Hemostasis Societies of North America 2018, Poster 79.

Vaccination lags in children with sickle cell disease, Wagner AL et al. J Pediatr. 2018 May;196:223-9.

Idarucizumab reversed dabigatran despite severe renal dysfunction, Eikelboom JW et al. ACC 18, the annual meeting of the American College of Cardiology, Abstract 1231M-11.