title: The Safety and Efficacy of Lysine Analogues in Cancer Patients: A Systematic Review and Meta-Analysis.
abstract: Lysine analogues are effective agents used for the reduction of blood loss and transfusion. However, the safety of lysine analogues in cancer patients remains in question due to a potential risk of venous thromboembolism (VTE). The objective of our review is to investigate safety and efficacy of lysine analogue administration in the patients with cancer. Medline, Embase, and The Cochrane Library were searched from inception to June, 2016. Reference lists of retrieved studies were searched to identify additional publications. We included randomized clinical trials in adult cancer patients for which a lysine analogue was administered for the purpose of blood loss reduction. Abstract and full-text selection as well as data extraction and risk of bias assessment was done by 2 independent reviewers. The primary outcome was venous thromboembolic events. Secondary outcomes were other adverse events, blood transfusion, and blood loss. Overall, 11studies involving 1177 patients evaluated at least one of the primary or secondary outcomes. Nine studies evaluated the effects of tranexamic acid, one study evaluated the effects of aminocaproic acid and one study examined both agents. No increased risk of venous thromboembolism was observed for patients who received lysine analogues compared to control (Peto OR 0.58; 95% CI 0.26-1.28). The administration of a lysine analogue significantly decreased both transfusion risk (pooled RR 0.52, 95% CI 0.34-0.80) and blood loss (SMD -1.57, 95% CI -2.21 to -0.92). Among 3 eligible studies, no increased risk was observed for mortality (Peto OR 1.01; 95% CI 0.14-7.18) or infection (OR 0.58; 95% CI 0.27-1.27). The safety of lysine analogues in cancer patients has not been extensively studied. Based on the available literature, lysine analogue use has not been associated with increased risk of venous thromboembolism or other adverse events, while being effective in reducing blood loss and subsequent transfusion.
authors.affiliation: Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada; University of Ottawa, School of Epidemiology, Community Medicine and Preventive Medicine, Ottawa, ON, Canada.
authors.forename: Joshua
authors.initials: J
authors.lastname: Montroy
authors.affiliation: Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada; University of Ottawa, School of Epidemiology, Community Medicine and Preventive Medicine, Ottawa, ON, Canada.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Fergusson
authors.affiliation: Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Hutton
authors.affiliation: Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Luke T
authors.initials: LT
authors.lastname: Lavallée
authors.affiliation: Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Morash
authors.affiliation: Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Ilias
authors.initials: I
authors.lastname: Cagiannos
authors.affiliation: Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Sonya
authors.initials: S
authors.lastname: Cnossen
authors.affiliation: Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Dean A
authors.initials: DA
authors.lastname: Fergusson
authors.affiliation: Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada. Electronic address: rbreau@toh.on.ca.
authors.forename: Rodney H
authors.initials: RH
authors.lastname: Breau
mesh_terms: D000328:Adult; D015119:Aminocaproic Acid / Q000008:administration & dosage; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D017707:Erythrocyte Transfusion; D006801:Humans; D008239:Lysine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy*; D061214:Patient Safety; D017713:Platelet Transfusion; D016032:Randomized Controlled Trials as Topic; D014148:Tranexamic Acid / Q000008:administration & dosage; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications / Q000517:prevention & control*
chemical_list: D014148:Tranexamic Acid; D008239:Lysine; D015119:Aminocaproic Acid
keywords: Blood transfusion; Cancer; Lysine analogue; Surgery; Venous thromboembolism