Abstract:BackgroundKnowledge about the impact of Low-Molecular-Weight Heparin (LMWH) on the coagulation system in patients undergoing minimal invasive lung cancer surgery is sparse. The aim of this study was to assess the effect of LMWH on the coagulation system in patients undergoing Video-Assisted Thoracoscopic Surgery (VATS) lobectomy for primary lung cancer.MethodsSixty-three patients diagnosed with primary lung cancer undergoing VATS lobectomy were randomized to either subcutaneous injection with dalteparin (Fragm… Show more
“…Commonly included malignancies include but are not limited to; lung (n ¼ 20), 3,4,13,14,18 19,20,26,29-41 colorectal (n ¼ 13), 4,20,26,[30][31][32][33]37,38,[42][43][44][45] pancreatic (n ¼ 16), 3,4,20,26,27,[30][31][32][33][35][36][37]39,44,46,47 breast (n ¼ 13), 3,4 20,26,30,31,34,36-39,44,45 and GI (n ¼ 11). 3,4,20,26,28,30,36,39,[48][49][50] Eleven studies were placebo-controlled (24%), 3,4,26,33,34,37-39 44,51,52 21 studies compared with no LMWH treatment (standard of care; 47%), 13,14,18,19,27,[29][30][31][32]35,…”
Section: Characteristics Of Included Studiesmentioning
confidence: 99%
“…LMWHs used included enoxaparin (n ¼ 14), 15,18,28,32,39,47 49,53,55,57,59-62 dalteparin (n ¼ 13), 14,19,27,29,30,36,38,[44][45][46]51 52,58 nadroparin (n ¼ 9), 3,4,20,26,35,37,40,50,54 bemiparin (n ¼ 2), 13,48 tinzaparin (n ¼ 2), 41,43 certoparin (n ¼ 1), 34 semuloparin (n ¼ 1), 33 and two studies which used enoxaparin, dalteparin, and nadroparin. 31,42 The type of LMWH used was unclear in one study.…”
Section: Characteristics Of Included Studiesmentioning
Background Low molecular weight heparins (LMWH) are often used as a first-line therapy for the prevention of thrombosis in cancer patients. Preclinical evidence from animal models suggests that LMWH may have antimetastatic properties. Clinical evidence of this effect is inconclusive. The objective of this systematic review is to evaluate the effect of LMWH on overall survival in patients with solid tumor malignancies.
Methods MEDLINE, Embase, and The Cochrane Central Register of Controlled trials were searched from inception to November 26, 2018. We included randomized controlled trials that compared LMWH to placebo, a no-treatment arm, or a short-term prophylactic course of LMWH in adult patients with solid tumors. The primary outcome was overall survival. Secondary outcomes included progression-free survival, the occurrence of venous thromboembolism, and major bleeding events. The risk of bias was assessed in duplicate using the Cochrane Risk-of-Bias tool.
Results Forty-five articles were included in the review. Overall, no difference in overall survival was observed between groups (risk ratio: 1.00; 95% confidence interval: 0.98–1.02; I2 = 36.5%). In our a priori defined subgroup analyses, the effect was not shown to vary by the type of LMWH, duration of LMWH use, length of study follow-up, comparator used in the study, or the setting in which the LMWH was administered. The majority of studies had an unclear risk of bias for at least one methodological criterion.
Conclusion Although LMWH is thought to possess antimetastatic properties and thus have the potential to improve survival in cancer patients, existing data do not support this hypothesis.
“…Commonly included malignancies include but are not limited to; lung (n ¼ 20), 3,4,13,14,18 19,20,26,29-41 colorectal (n ¼ 13), 4,20,26,[30][31][32][33]37,38,[42][43][44][45] pancreatic (n ¼ 16), 3,4,20,26,27,[30][31][32][33][35][36][37]39,44,46,47 breast (n ¼ 13), 3,4 20,26,30,31,34,36-39,44,45 and GI (n ¼ 11). 3,4,20,26,28,30,36,39,[48][49][50] Eleven studies were placebo-controlled (24%), 3,4,26,33,34,37-39 44,51,52 21 studies compared with no LMWH treatment (standard of care; 47%), 13,14,18,19,27,[29][30][31][32]35,…”
Section: Characteristics Of Included Studiesmentioning
confidence: 99%
“…LMWHs used included enoxaparin (n ¼ 14), 15,18,28,32,39,47 49,53,55,57,59-62 dalteparin (n ¼ 13), 14,19,27,29,30,36,38,[44][45][46]51 52,58 nadroparin (n ¼ 9), 3,4,20,26,35,37,40,50,54 bemiparin (n ¼ 2), 13,48 tinzaparin (n ¼ 2), 41,43 certoparin (n ¼ 1), 34 semuloparin (n ¼ 1), 33 and two studies which used enoxaparin, dalteparin, and nadroparin. 31,42 The type of LMWH used was unclear in one study.…”
Section: Characteristics Of Included Studiesmentioning
Background Low molecular weight heparins (LMWH) are often used as a first-line therapy for the prevention of thrombosis in cancer patients. Preclinical evidence from animal models suggests that LMWH may have antimetastatic properties. Clinical evidence of this effect is inconclusive. The objective of this systematic review is to evaluate the effect of LMWH on overall survival in patients with solid tumor malignancies.
Methods MEDLINE, Embase, and The Cochrane Central Register of Controlled trials were searched from inception to November 26, 2018. We included randomized controlled trials that compared LMWH to placebo, a no-treatment arm, or a short-term prophylactic course of LMWH in adult patients with solid tumors. The primary outcome was overall survival. Secondary outcomes included progression-free survival, the occurrence of venous thromboembolism, and major bleeding events. The risk of bias was assessed in duplicate using the Cochrane Risk-of-Bias tool.
Results Forty-five articles were included in the review. Overall, no difference in overall survival was observed between groups (risk ratio: 1.00; 95% confidence interval: 0.98–1.02; I2 = 36.5%). In our a priori defined subgroup analyses, the effect was not shown to vary by the type of LMWH, duration of LMWH use, length of study follow-up, comparator used in the study, or the setting in which the LMWH was administered. The majority of studies had an unclear risk of bias for at least one methodological criterion.
Conclusion Although LMWH is thought to possess antimetastatic properties and thus have the potential to improve survival in cancer patients, existing data do not support this hypothesis.
“…1 ). Patients randomized to the LMWH arm were excluded in the present study, and these results are published elsewhere [ 10 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…This is a sub-study of a larger study, where patients undergoing curative surgery for primary lung cancer with the use of VATS were randomized to either LMWH or no thromboprophylaxis [ 10 ]. In that study, we found that the use of LMWH administered once daily as thromboprophylaxis did not alter the coagulation profile per se.…”
Section: Discussionmentioning
confidence: 99%
“…The present study is a sub-study to a larger randomized study already published, and the design is thus reported elsewhere [ 10 ].…”
BackgroundChanges in the coagulation system in patients undergoing surgery for lung cancer have been sparsely investigated and the impact of the surgical trauma on the coagulation system is largely unknown in these patients. An increased knowledge could potentially improve the thromboprophylaxis regimes. The aim of this study was to assess the coagulation profile evoked in patients undergoing curative surgery by Video-Assisted Thoracoscopic Surgery (VATS) lobectomy for primary lung cancer.MethodsThirty-one patients diagnosed with primary lung cancer undergoing VATS lobectomy were prospectively included. The coagulation profile was assessed preoperatively and in the first two days postoperatively using a wide range of standard coagulation tests, dynamic whole blood coagulation measured by rotational thromboelastometry (ROTEM®) and thrombin generation evaluated by calibrated automated thrombography. Patients did not receive thromboprophylactic treatment. Data was analyzed using repeated measures one-way ANOVA.ResultsThe standard coagulation parameters displayed only subtle changes after surgery and the ROTEM® and thrombin generation results remained largely unchanged.ConclusionsPatients undergoing VATS lobectomy are normocoagulable in the preoperative state and a VATS lobectomy does not significantly influence the coagulation.Trial registrationThe trial is registered at ClinicalTrials.gov (Identifier: NCT01741506) and at EudraCTno. 2012–002409-23. Registered December 2012.
The aim of this study was to evaluate the applicability of bedside ultrasonography for the diagnosis of deep venous thrombosis (DVT) in patients infected with corona virus disease 2019 (COVID-19) with and without treatment with low molecular weight heparin (LMWH). Methods: We retrospectively analyzed the records of deceased and surviving patients in whom ultrasonography detected or not a DVT, and in whom LMWH was or not prescribed. Results: The incidence of DVT is higher in the deceased (33/35) than in the surviving (22/46) patients. LMWH was administered in a larger proportion of surviving (18/22) than of deceased (18/33) patients. D-dimer concentrations decreased in patients who received LMWH in both groups. Conclusions: There was a high incidence of DVT in patients who succumbed to COVID-19. Bedside ultrasonography can detect the presence of DVT as early as possible and help assessing the risk of venous thromboembolism, allowing early and reasonable use of LMWH. K E Y W O R D S bedside ultrasonography, COVID-19, deep venous thrombosis, low molecular weight heparin 1 | INTRODUCTION Corona virus disease 2019 (COVID-19), which was first reported in Wuhan, China, in late December 2019, is currently spreading to other provinces in mainland China and to other countries around the globe, with major public health and economic consequences. 1 Bedside ultrasonography can detect deep venous thrombosis (DVT) in a timely and accurate manner, which helps assessing the risk of venous thromboembolism. Bedside checks can be repeated in a short time span because there is no radiation, and can provide safe and important diagnostic information for patients with COVID-19. Based on existing studies, the clinical manifestations and pathological results of COVID-19 infection are associated with acute respiratory distress syndrome (ARDS), 2 characterized by respiratory distress and difficulty to correct hypoxemia, with a high mortality rate, 3 due to excessive intra-alveolar fibrin deposition. The imbalance between activation of coagulation and inhibition of fibrinolysis in patients with ARDS leads to fibrin formation, which occurs both systemically and in the lungs and airspace. 4 Nearly 20% of COVID-19 patients present severe coagulation abnormalities, which may occur in almost all of the severe and critical ill COVID-19 cases. 5 The large amount of thrombin can induce the expression of E-selectin, P-selectin, and platelet-activating factors, promote the aggregation and adhesion of platelets and activated neutrophils, and strengthen the interaction between endothelial cells and neutrophils, 6 Pu Zhang and Yali Qu contributed equally to this study.
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