title: Risk of venous thromboembolism with the erythropoiesis-stimulating agents (ESAs) for the treatment of cancer-associated anemia: a meta-analysis of randomized control trials.
abstract: BACKGROUND
  In anemic patients receiving myelosuppressive chemotherapy, erythropoiesis-stimulating agents (ESAs) raise hemoglobin levels and reduce transfusion requirements, but ESA-related safety concerns exist. To evaluate the overall risk of venous thromboembolism (VTE) associated with the use of ESAs, a systematic review and meta-analysis of published randomized controlled trials (RCT) was performed.
  
  
  METHODS
  The databases of PubMed and Web of Science were searched from January 1966 until December 2012 and abstracts presented at American Society of Clinical Oncology conferences held between January 2000 and December 2012 were searched to identify relevant clinical trials. Summary incidence rates, relative risks (RRs), and 95% confidence intervals (CIs) were calculated.
  
  
  RESULTS
  Data from a total of 11,632 patients with cancer in 50 RCTs were identified and included for meta-analysis. Among those patients receiving ESAs, the summary incidences of all-grade VTE were 7.62%. Patients with cancer who received ESAs had increased VTE risks (482 events among 6,238 patients treated with ESA vs. 269 events among 5,394 control patients; RR=1.75; 95% CI, 1.49-2.05). The highest risk of VET was found in patients with ovarian and cervical cancer for 2.45 (1.12-5.33).
  
  
  CONCLUSIONS
  The use of ESAs was significantly associated with an increased risk of developing VTE in cancer patients receiving this drug. The risks of VTE may vary with various tumor types.
authors.affiliation: First Department of Respiratory Medicine, Nanjing Chest Hospital, Nanjing, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Zhan
authors.affiliation: Department of Critical Care Medicine, 81 Hospital of PLA, Nanjing, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Wang
authors.affiliation: First Department of Respiratory Medicine, Nanjing Chest Hospital, Nanjing, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Qian
authors.affiliation: First Department of Respiratory Medicine, Nanjing Chest Hospital, Nanjing, China. yulike_nanjing@163.com.
authors.forename: Li-Ke
authors.initials: LK
authors.lastname: Yu
keywords: Erythropoiesis-stimulating agents (ESAs); meta-analysis; randomized controlled trials (RCT); venous thromboembolism (VTE)