title: Treatment for disseminated intravascular coagulation in patients with acute and chronic leukemia.
abstract: BACKGROUND
  Disseminated intravascular coagulation (DIC) is an acquired syndrome characterized by systemic intravascular activation of coagulation, leading to deposition of fibrin in the bloodstream, that may occur in patients with acute and chronic leukemia.
  
  
  OBJECTIVE
  To assess the clinical effectiveness and safety of any pharmacological intervention for treating DIC in acute or chronic leukemia.
  
  
  METHODS
  The search strategy included the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 12), MEDLINE (1950 to 28 October 2010), EMBASE (1980 to 10 October 2010), LILACS (1982 to 19 August 2010) and African Index Medicus (1993 to 19 August 2010). There was no language restriction. We sought additional randomized controlled trials (RCTs) from the World Health Organization (WHO) Clinical Trials Registry Platform and by using the reference lists of primary studies found.
  
  
  METHODS
  RCTs assessing the effectiveness of interventions for treating disseminated intravascular coagulation (DIC) in patients with acute and chronic leukemia.
  
  
  METHODS
  Two review authors independently performed study selection, risk of bias assessment and data extraction.
  
  
  RESULTS
  Four RCTs (126 participants) met the inclusion criteria. These trials evaluated the human activated protein C, recombinant human soluble thrombomodulin, tranexamic acid and dermatan sulphate. Included RCTs reported data on mortality and bleeding. The included RCTs were classified as: 1) including patients with or without leukemia, and 2) only including patients with leukemia. However, data were not reported for the leukemia subgroup. We were not able to pool results from studies due to the inconsistency in the measurement and reporting of mortality and bleeding data. The included studies were at high risk of bias.
  
  
  CONCLUSIONS
  We found four RCTs which reported mortality and bleeding data. It is not possible to determine whether human activated protein C, recombinant human soluble thrombomodulin, tranexamic acid and dermatan sulphate are effective or harmful for patients presenting with DIC related to acute or chronic leukemia. The effects of these interventions need to be tested in sufficiently powered RCTs. Outcome measures should include in-hospital mortality from any cause, overall mortality, incidence of resolution of respiratory failure, renal failure, shock and safety. The definition of bleeding should be standardized in these patients.
authors.affiliation: Universidad de Carabobo and Iberoamerican Cochrane Network, Valencia, Edo. Carabobo, Venezuela.
authors.forename: Arturo J
authors.initials: AJ
authors.lastname: Martí-Carvajal
authors.forename: Daniel
authors.initials: D
authors.lastname: Simancas
authors.forename: Andrés Felipe
authors.initials: AF
authors.lastname: Cardona
mesh_terms: D000208:Acute Disease; D000925:Anticoagulants / Q000627:therapeutic use*; D002908:Chronic Disease; D003871:Dermatan Sulfate / Q000627:therapeutic use; D004211:Disseminated Intravascular Coagulation / Q000188:drug therapy*; D006801:Humans; D007938:Leukemia / Q000097:blood / Q000150:complications*; D011486:Protein C / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D018180:Thrombomodulin / Q000627:therapeutic use; D014148:Tranexamic Acid / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D011486:Protein C; D018180:Thrombomodulin; D003871:Dermatan Sulfate; D014148:Tranexamic Acid