Montroy, J., Fergusson, N.A., Hutton, B., Lavallee, L.T., Morash, C., Cagiannos, I., . . . Breau, R.H. (2017). The safety and efficacy of lysine analogues in cancer patients: A systematic review and meta-analysis. Transfusion Medicine Reviews, 31, 141–148.

STUDY PURPOSE: The primary aim was to evaluate the safety of lysine analogs administered to patients with cancer, with respect to the development of thromboembolic events. The secondary outcome was the efficacy of lysine analogs administered to patients with cancer, with respect to transfusion risk and blood loss.

TYPE OF STUDY: Meta-analysis and systematic review

DATABASES USED: MEDLINE, Embase, Cochrane Library

YEARS INCLUDED: Inception to June 2016

INCLUSION CRITERIA: Randomized controlled trials comparing administration of a lysine analog to either placebo or active control, or standard of care in surgical and nonsurgical patients with cancer. 

EXCLUSION CRITERIA: No specific exclusion criteria

TOTAL REFERENCES RETRIEVED: N = 5,627 records were retrieved.

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Studies were selected for review based on PRISMA guidelines. A standardized data review extraction form was piloted by the two reviewers; the Cochrane Risk of Bias Tool was utilized to assess the risk of bias.

• FINAL NUMBER STUDIES INCLUDED: N = 11 
• TOTAL PATIENTS INCLUDED IN REVIEW: 1,177
• SAMPLE RANGE ACROSS STUDIES: 12-219
• KEY SAMPLE CHARACTERISTICS: surgical and nonsurgical patients with cancer were included; TXA was administered in nine trials, EACA in one, and both lysine analogs in one study.

PHASE OF CARE: Multiple phases of care     

APPLICATIONS: Elder care, palliative care

There was a significant reduction in blood loss noted in 9 of 11 studies in which a lysine analog was administered. Data from two studies were not included in the meta-analysis because of statistical heterogeneity between trials. In the seven studies reporting transfusion data, there was a significant decrease in the risk of receiving a blood transfusion in patients who had received a lysine analog.

The administration of a lysine analog was correlated with a significant reduction in blood loss and the risk of receiving a blood transfusion in patients with cancer.

• Limited number of studies included
• Mostly low-quality and/or high risk of bias studies   
• High heterogeneity   
• Low sample sizes
• Efficacy of lysine analogs administered to patients with cancer, with respect to transfusion risk and blood loss, was a secondary outcome. It is not clear from this review what search items were used: were only studies evaluated which included information regarding efficacy and VTE? If so, that would omit studies which only evaluated efficacy.

The administration of lysine analogs in patients with cancer has been shown to be efficacious in the reduction of blood loss and in reducing the risk of receiving a blood transfusion. Nurses, however, need to be aware of the potential inherent risks of VTE-associated administration of these agents. This has not been adequately studied, to date.