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Marti-Carvajal, A.J., Anand, V., & Sola, I. (2015). Treatment for disseminated intravascular coagulation in patients with acute and chronic leukemia. Cochrane Database of Systematic Reviews, 6, CD008562.
STUDY PURPOSE: To assess the benefits and harms of pharmacologic interventions for treating patients with leukemia experiencing disseminated intravascular coagulation (DIC) to update a prior systematic review
TYPE OF STUDY: Meta-analysis and systematic review
Search Strategy
DATABASES USED: MEDLINE OVID, LILACS, CENTRAL, WHO International Clinical Trials
INCLUSION CRITERIA: Randomized, controlled trials (RCTs); patients of any age with acute or chronic leukemia; eligible RCTs had to compare confentional interventions with and without anticoagulants, procoagulants, or antifibrolynics
EXCLUSION CRITERIA: Not specified
Literature Evaluated
TOTAL REFERENCES RETRIEVED: 9,027
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane risk of bias assessment; used GRADE criteria for strength of evidence; studies included were of low quality because of small sample sizes and study design.
Sample Characteristics
FINAL NUMBER STUDIES INCLUDED = 4 studies
TOTAL PATIENTS INCLUDED IN REVIEW = 388
SAMPLE RANGE ACROSS STUDIES: 10–132
Phase of Care and Clinical Applications
PHASE OF CARE: Not specified or not applicable
Results
Interventions included human activated protein C versus heparin, recombinant human soluble thrombomodulin versus heparin, tanexamic acid versus placebo, and dermatan sulfate versus heparin. Only one study was found for each intervention. No significant differences in bleeding with protein C or dermatan sulfate existed. Recombinant human soluble thrombomodulin was associated with improvement in bleeding symptoms compared to heparin, and lower scoring of hemorrhagic problems with tranexamic acid compared to placebo.
Conclusions
Insufficient high quality evidence exists to fully evaluate these interventions.
Limitations
Limited number of studies included
Mostly low quality/high risk of bias studies
Low sample sizes
Some studies included patients with DIC from other causes, and the findings were not reported separately for patients with leukemia, further reducing the relevant samples for consideration.
Nursing Implications
Extremely limited evidence regarding the effects of pharmacologic interventions for the management of DIC and associated bleeding exists compared to usual practice using heparin.