[cochrane-announce] New and updated Cochrane summaries

New and updated no-reply at web.cochrane.org
Fri Jun 27 13:02:41 UTC 2014

New and updated

Blood thinners for the prevention of clots in patients with cancer  
undergoing surgery

Posted: 25 Jun 2014 03:00 PM PDT


     Akl EA, Kahale L, Sperati F, Neumann I, Labedi N, Terrenato I, Barba M,  
Sempos EV, Muti P, Cook D, Sch√ľnemann H


Patients with cancer undergoing surgical procedures are at an increased  
risk of blood clots. The blood thinner administered to prevent these clots  
can be either an unfractionated heparin (UFH) or low molecular weight  
heparin (LMWH). These two blood thinners may have different effectiveness  
and safety profiles.

Study characteristics

We searched scientific databases for clinical trials looking at the effects  
of UFH and LMWH on death, pulmonary embolism (blood clot in the lungs),  
deep vein thrombosis (blood clot in the veins of the legs), bruising,  
bleeding, and need for blood transfusion in patients having operations. We  
included people of any age or sex. The evidence is current to February 2013.

Key results

We found 16 studies of 12,890 patients with cancer. There was no evidence  
to show that LMWH was better than UFH for death, asymptomatic deep vein  
thrombosis, pulmonary embolism, or bleeding. There was less bruising around  
the wound and more blood transfusion during the operation with LMWH  
compared with UFH. Further trials are needed to clarify the effectiveness  
of LMWH and UFH.

Quality of evidence

The overall quality of evidence of these studies was moderate.

Different infusion durations for preventing platinum-induced hearing loss  
in children with cancer

Posted: 25 Jun 2014 03:00 PM PDT


     van As JW, van den Berg H, van Dalen EC

Platinum-based chemotherapy, including cisplatin, carboplatin or  
oxaliplatin, or a combination of these, is used to treat different types of  
childhood cancer. Unfortunately, one of the most important adverse effects  
of platinum chemotherapy is hearing loss. This can occur not only during  
treatment but also years after the end of treatment. Although it is not  
life-threatening, the loss of hearing, especially during the first three  
years of life, may lead to difficulties with school performance and  
psychosocial functioning. Therefore, prevention of platinum-induced hearing  
loss is very important and might improve the quality of life of children  
undergoing cancer treatment and those who have survived treatment with  
platinum-based chemotherapy.

The review authors identified one randomised study comparing a continuous  
cisplatin infusion with a one hour cisplatin bolus infusion in children  
with neuroblastoma. For the continuous infusion, cisplatin was administered  
on days 1 to 5 of the treatment cycle but it is not clear if the infusion  
duration was a total of 5 days. The study had methodological problems and  
only results from shortly after induction therapy were available. At the  
moment there is no evidence showing that the use of a different cisplatin  
infusion duration prevents hearing loss or adversely affects tumour  
response and adverse effects. No data were available for the other outcomes  
of interest (i.e. tinnitus, overall survival, event-free survival and  
quality of life) or for other (combinations of) infusion durations or other  
platinum analogues. We need more high quality research before definite  
conclusions can be made about the usefulness of different platinum infusion  
durations to prevent hearing loss in children with cancer.

The effects of antibiotics on toothache caused by inflammation or infection  
at the root of the tooth in adults

Posted: 25 Jun 2014 03:00 PM PDT


     Cope A, Francis N, Wood F, Mann MK, Chestnutt IG

This review, carried out by authors of the Cochrane Oral Health Group, has  
been produced to assess the effects of antibiotics on pain and swelling in  
two conditions commonly responsible for causing dental pain when given with  
or without dental treatment (such as extraction, drainage of a swelling or  
root canal treatment).


Dental pain is a common problem and can arise when the nerve within a tooth  
dies due to progressing decay or severe trauma. The tissue around the end  
of the root then becomes inflamed and this can lead to acute pain, which  
gets worse on biting. Without treatment, bacteria can infect the dead tooth  
and cause a dental abscess, which can lead to swelling and spreading  
infection that may be life threatening.

The recommended treatment of this form of toothache is the removal the dead  
nerve and associated bacteria. This is usually done by dental extraction or  
root canal treatment. Antibiotics should only be prescribed when there is  
severe infection that has spread from the tooth. However, some dentists  
still routinely prescribe oral antibiotics to people with acute dental  
conditions that have no signs of spreading infection.

Minimising inappropriate antibiotic prescribing is plays a key role in  
limiting the development of antibiotic-resistant bacteria. Since dentists  
prescribe approximately 8% to 10% of all primary care antibiotics in  
developed countries, dental prescribing may contribute to antibiotic  
resistance. Therefore, it is important that antibiotics should only be used  
when they are clinically beneficial for the person.

Study characteristics

The evidence on which this review is based was up to date as of 1 October  
2013. We searched scientific databases and found two trials, with a 62  
participants included in the analysis. Both trials were conducted at  
university dental schools in the USA and evaluated the use of oral  
antibiotics in the reduction of pain and swelling reported by adults after  
having the first stage of root canal treatment under local anaesthetic. The  
antibiotic used in both trials was penicillin VK and all participants also  
received painkillers.

Key results

The two studies included in the review reported that there were no clear  
differences in the pain or swelling reported by participants who received  
oral antibiotics compared with a placebo (a dummy treatment) when provided  
in conjunction with the first stage of root canal treatment and  
painkillers, but the studies were small and we could not exclude  
potentially important differences between groups. Neither study examined  
the effect of antibiotics delivered by themselves, without dental treatment.

One trial reported side effects among participants: one person who received  
the placebo medication had diarrhoea and one person who received  
antibiotics experienced tiredness and reduced energy after their operation.

Quality of evidence

We judged the quality of evidence to be very low. There is currently  
insufficient evidence to be able to determine the effects of antibiotics in  
these conditions.

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