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Review
. 2024 Sep 24;16(9):e70078.
doi: 10.7759/cureus.70078. eCollection 2024 Sep.

Venous Thromboembolism Prophylaxis in Patients Treated for Acute Lymphoblastic Leukemia: A Comprehensive Systematic Review and Meta-Analysis

Bareq S Al Lami  1 , Shad B Aziz  2 , Yousif N Al-Tawil  2 , Rawen Aras  2 , Blnd D Dlshad  1 , Rose Wilya  2 , Hanan Slevanay  2 , Zahraa Sarkawt  2 , Taha Fadhel  2 , Avin Salahaddin  2 , Lazha Abdulla  2 , Gunai Hussein  2 , Vena Abdulwahhab  2 , Hivi Albarznji  2
Affiliations
Review

Venous Thromboembolism Prophylaxis in Patients Treated for Acute Lymphoblastic Leukemia: A Comprehensive Systematic Review and Meta-Analysis

Bareq S Al Lami et al. Cureus. .

Abstract

Acute lymphoblastic leukemia (ALL) is a common malignancy in children, often treated with intensive chemotherapy regimens. Venous thromboembolism (VTE) poses a significant risk during ALL treatment, leading to suboptimal outcomes. Thromboprophylaxis is crucial in mitigating this risk, but its efficacy and safety remain uncertain. This systematic review and meta-analysis aimed to evaluate the effectiveness of thromboprophylaxis in reducing VTE incidence during ALL treatment, focusing on antithrombin, apixaban, and enoxaparin. A systematic literature search adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Randomized controlled trials (RCTs) investigating thromboprophylaxis in ALL were included. Data extraction and quality appraisal were performed independently by three authors. Meta-analysis was conducted using Review Manager software. Three RCTs met the inclusion criteria. Apixaban, enoxaparin, and antithrombin were assessed in these trials. Meta-analysis revealed significantly reduced odds of VTE with thromboprophylaxis compared to standard care (odds ratio (OR): 0.47, 95% confidence interval (CI) 0.29-0.75; relative risk (RR): 0.52, 95% CI 0.33-0.83). However, no significant difference in bleeding risk was observed (OR: 1.33, 95% CI 0.42-4.21; RR: 1.32, 95% CI 0.43-4.07). Heterogeneity among studies was moderate. This study showed that thromboprophylaxis with apixaban, enoxaparin, or antithrombin significantly reduces VTE incidence during ALL treatment. Despite some limitations, including heterogeneity and potential biases, these findings support the adoption of tailored thromboprophylaxis strategies to improve outcomes in ALL patients. Further research is warranted to optimize these approaches and address remaining uncertainties.

Keywords: all; antiocoagulation; l-asparaginase; malignancy; thrombophylaxis; vte.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart for the search process.
Figure 2
Figure 2. OR forest plot for the pooled studies' VTE event outcome.
OR: odds ratio, VTE: venous thromboembolism References: O' Brien et al. [10], Griener et al. [11], Mitchell et al. [12]
Figure 3
Figure 3. RR forest plot for the pooled studies' VTE event outcome.
RR: relative risk, VTE: venous thromboembolism References; O' Brien et al. [10], Griener et al. [11], Mitchell et al. [12]
Figure 4
Figure 4. OR funnel plot for the pooled studies' VTE event outcome.
OR: odds ratio, VTE: venous thromboembolism
Figure 5
Figure 5. OR forest plot for the pooled studies' bleeding event outcome
OR: odds ratio References: O' Brien et al. [10], Griener et al. [11], Mitchell et al. [12]
Figure 6
Figure 6. RR forest plot for the pooled studies' bleeding event outcome
RR: relative risk References: O' Brien et al. [10], Griener et al. [11], Mitchell et al. [12]
Figure 7
Figure 7. OR funnel plot for the pooled studies' bleeding event outcome
OR: odds ratio
See this image and copyright information in PMC

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