Updated meta-analysis of randomized controlled trials on primary outpatient thromboprophylaxis in patients with gastric and gastroesophageal junction cancers receiving chemotherapy

Kyaw Zin Thein; Thura Win Htut; Yin Mon Myat; Myat Min Han; Myint Aung Win; Ei Moe Phyu; Thein Hlaing Oo

doi:10.1080/08998280.2023.2225913

Updated meta-analysis of randomized controlled trials on primary outpatient thromboprophylaxis in patients with gastric and gastroesophageal junction cancers receiving chemotherapy

Proc (Bayl Univ Med Cent). 2023 Jul 3;36(5):635-640. doi: 10.1080/08998280.2023.2225913. eCollection 2023.

Authors

Kyaw Zin Thein¹, Thura Win Htut², Yin Mon Myat³, Myat Min Han⁴, Myint Aung Win⁵, Ei Moe Phyu⁶, Thein Hlaing Oo⁷

Affiliations

¹ Division of Hematology and Medical Oncology, Oregon Health and Science University/Knight Cancer Institute, Portland, Oregon, USA.
² Department of Hematology, Aberdeen Royal Infirmary, University of Aberdeen, NHS Grampian, Scotland, UK.
³ University College Dublin, Dublin, Ireland.
⁴ Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York, USA.
⁵ Department of Internal Medicine, Lewis Gale Medical Center, Salem, Virginia, USA.
⁶ Department of Hospital Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
⁷ Section of Benign Hematology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.

Abstract

Advanced gastric cancer is a highly thrombogenic cancer per Khorana score. Recent clinical practice guidelines suggest primary outpatient thromboprophylaxis (POTP) for patients with a Khorana score ≥2. We performed an updated meta-analysis to evaluate the benefit of POTP in patients with gastric cancer and gastroesophageal junction cancers receiving chemotherapy. Randomized controlled trials with reduction in venous thromboembolism (VTE) as a primary or secondary endpoint were incorporated. A total of 631 patients from subgroups of three randomized controlled trials were included. The VTE incidence was 1.6% and 5.1% in POTP and control groups, respectively (risk ratio 0.31; confidence interval 0.11 to 0.83; P = 0.02), with a number needed to treat of 29 to prevent one VTE event. Even though the recent clinical practice guidelines suggest POTP in patients with gastric cancer and gastroesophageal junction cancers, our meta-analysis findings do not support the routine use of POTP in those patients.

Keywords: Gastric cancer; gastro-esophageal junction cancer; meta-analysis; primary outpatient thromboprophylaxis; venous thromboembolism.