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Meta-Analysis
. 2018 Mar;24(2):226-234.
doi: 10.1177/1076029617696581. Epub 2017 Mar 14.

Tinzaparin for Long-Term Treatment of Venous Thromboembolism in Patients With Cancer: A Systematic Review and Meta-Analysis

M José Martínez-Zapata  1 , Alexander G Mathioudakis  2 , Shaker A Mousa  3 , Rupert Bauersachs  4   5
Affiliations
Meta-Analysis

Tinzaparin for Long-Term Treatment of Venous Thromboembolism in Patients With Cancer: A Systematic Review and Meta-Analysis

M José Martínez-Zapata et al. Clin Appl Thromb Hemost. 2018 Mar.

Abstract

Patients with cancer are at increased risk of recurrent venous thromboembolism (VTE) and bleeding. Thus, long-term treatment with anticoagulants for secondary prevention is challenging. The objective of this review was to evaluate current evidence on the safety and efficacy of tinzaparin compared with other anticoagulants for long-term VTE treatment in patients with cancer. Based on a preregistered protocol, we identified randomized controlled trials (RCTs) comparing long-term tinzaparin (therapeutic dose: 175 IU/kg) versus other anticoagulants for at least 3 months after an acute episode of VTE that included adult patients with underlying malignancy. We extracted predefined, clinically relevant outcomes of patients with cancer and, using standard methodology, pooled available data and assessed risk of bias and quality of evidence for each study. Three open-label RCTs evaluating 1169 patients with cancer were included in the analysis. Tinzaparin was associated with a significantly lower risk of recurrent VTE at the end of treatment (relative risk [RR], [95% confidence interval] 0.67 [0.46-0.99]) and at longest follow-up (RR: 0.58 [0.39-0.88]) and showed a lower risk of clinically relevant non-major bleeding at the end of treatment (RR: 0.71 [0.51-1.00]). No significant between-treatment differences were found for all-cause mortality (RR: 1.09 [0.91-1.30]) or fatal and non-fatal major bleeding events (RR: 1.06 [0.56-1.99]). The overall quality of evidence was deemed moderate, mainly due to small sample size in 2 of the studies and limited number of events in the meta-analyses. In conclusion, both short- and long-term treatments with tinzaparin were found to be superior to vitamin K antagonists for avoiding recurrences of VTE.

Keywords: anticoagulant; malignancy; tinzaparin; venous thromboembolism.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: M. José Martínez-Zapata and Alexander G. Mathioudakis are collaborators of INPECS and have not received payment from LEO Pharma. Dr Bauersachs has received honoraria for consultation from Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, LEO Pharma, and Pfizer.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram.
Figure 2.
Figure 2.
Risk of bias summary: review authors’ judgment about each risk of bias for each included study.
Figure 3.
Figure 3.
All recurrent venous thromboembolism (subgroup analysis by comparison group).
Figure 4.
Figure 4.
All recurrent venous thromboembolism (subgroup analysis by follow-up time).
Figure 5.
Figure 5.
Other secondary outcomes at the end of treatment.
See this image and copyright information in PMC

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