门诊癌症患者的动脉血栓栓塞 (ATE) 发生率因原发肿瘤部位而异。然而，尚不清楚这是否会改变预防性抗​​凝治疗 ATE 的利弊关系。因此，我们根据原发肿瘤部位，系统评估了抗凝药物在动态癌症患者中预防 ATE 的有效性和安全性。我们使用 Medline、Embase、SCOPUS 和 CENTRAL 进行了系统评价，并纳入了比较预防性抗凝与不抗凝的随机试验在开始肿瘤定向全身治疗的门诊癌症患者中。使用随机效应模型按原发肿瘤部位对症状性 ATE（急性缺血性中风、急性心肌梗死或外周动脉闭塞）和大出血的发生率以及抗凝引起的风险差异 (RD) 进行荟萃分析。我们纳入了 10 项随机对照试验，涉及 9,875 名患者，随访时间为 3.3 至 68 个月（中位数 6.6）个月。虽然预防性抗凝并不能总体降低 ATE 风险（RD -0.49%；95% CI -0.49% 至 0.01%；I2=0%），但它对胰腺癌患者具有保护作用（RD -3.2%；95% CI - 5.7% 至 -0.8%；I2=0%），但未发现大出血增加（RD -1.4%；95% CI -4.6% 至 1.8%；I2=0%）。预防性抗凝与其他肿瘤部位的 ATE 风险降低无关。根据现有证据，总体而言，预防性抗凝并不能降低动态癌症患者的 ATE 风险。然而，我们观察到随机接受抗凝治疗的胰腺癌患者中 ATE 发生率较低。应在未来的研究中评估预防性使用抗凝剂以减少胰腺癌中的 ATE。© 作者 2024。由牛津大学出版社代表欧洲心脏病学会出版。

Incidence of arterial thromboembolism (ATE) among ambulatory cancer patients varies by primary tumor site. However, it is unclear whether this alters the benefit-to-harm profile of prophylactic anticoagulation for ATE prevention. Therefore, we systematically evaluated the efficacy and safety of anticoagulants for ATE prevention among ambulatory cancer patients according to the primary tumor site.We conducted a systematic review using Medline, Embase, SCOPUS, and CENTRAL, and included randomized trials comparing prophylactic anticoagulation to no anticoagulation among ambulatory cancer patients who initiated tumor-directed systemic therapy. Incidence of symptomatic ATE (acute ischemic stroke, acute myocardial infarction or peripheral artery occlusion) and major bleeding, as well as risk differences (RDs) attributable to anticoagulation were meta-analyzed by primary tumor site using random-effects modeling. We included 10 randomized controlled trials with 9,875 patients with follow-up ranging from 3.3 to 68 (median 6.6) months. While prophylactic anticoagulation did not reduce ATE risks overall (RD -0.49%; 95% CI -0.49% to 0.01%; I2=0%), it conferred a protective effect among pancreatic cancer patients (RD -3.2%; 95%CI -5.7% to -0.8%; I2=0%) without a detectable increase in major bleeding (RD -1.4%; 95% CI -4.6% to 1.8%; I2=0%). Prophylactic anticoagulation was not associated with ATE risk reduction in other tumor sites.Based on available evidence, prophylactic anticoagulation did not reduce ATE risk among ambulatory cancer patients overall. However, we observed lower incidence of ATE among pancreatic cancer patients randomized to receive anticoagulation. Prophylactic anticoagulant use to reduce ATEs in pancreatic cancer should be evaluated in future research.© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.