Thromboprophylaxis for Catheter-Related Thrombosis in Patients with Cancer: A Systematic Review.
Bibliographic record
Abstract
Abstract Background Patients with malignancy have an overall 4-fold increased relative risk of developing a venous thrombosis. Central venous catheters are commonly used in patients with cancer (chemotherapy, blood products, parenteral nutrition, etc) and further increase the absolute risk of thrombosis in this population. Thromboprophylaxis to prevent catheter-related thrombosis in patients with cancer is controversial. Both low-molecular-weight-heparin (LMWH) and low dose warfarin have been studied in adults. We sought to summarize and quantify the clinical effects of LMWH and low dose warfarin to prevent catheter-related thrombosis in patients with cancer. Methods A systematic literature search strategy was used to identify potential trials on MEDLINE (1950 to January week 4 2007), EMBASE (1980 to 2007 week 5), the Cochrane Register of Controlled Trials (1st quarter 2007) and all EBM Reviews (4th quarter of 2006) using an OVID interface. RCTs were evaluated using a previously validated scale (Jadad scale) and assessed for allocation concealment. The primary outcome measure was symptomatic catheter-related thrombosis. Secondary outcome measures included: clinically significant catheter-related thrombosis, death and bleeding episodes. Relative risk (RR) was used as the primary measurement with 95% confidence intervals (CIs). Pooled measurements were calculated for randomized clinical trials using a random-effects model. Results In total, 510 records were identified and 16 records (14 articles and 2 abstracts) were deemed potentially eligible. 6 articles and one abstract met our inclusion criteria; 3 investigated LMWH and 4 low dose warfarin. Three studies were double-blinded and 2 reported on allocation concealment. The pooled RR of symptomatic catheter-related thrombosis for LMWH thromboprophylaxis was 0.43 (95% CI: 0.12–1.56). The pooled RR of symptomatic catheter-related thrombosis for low-dose warfarin thromboprophylaxis was 0.82 (95% CI: 0.46–1.47). All RCTs also reported the proportion of clinically significant catheter-related thrombosis. The pooled RR was 0.42 (95% CI: 0.12–1.42) and 0.74 (95% CI: 0.41–1.32) for LMWH and warfarin respectively. Very few studies reported any adverse events (death, major and minor bleeding). Conclusions Based on the available data, we cannot recommend routine thromboprophylaxis for patients with cancer receiving a central venous catheter. Further studies with a greater number of enrolled patients are required before we can draw firmer conclusions regarding its utility.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.028 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.004 |
| Bibliometrics | 0.008 | 0.011 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".