What is the role of anticoagulant therapy in the treatment of venous thromboembolism (VTE)?

Updated: Nov 05, 2020
  • Author: Vera A De Palo, MD, MBA, FCCP; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Answer

The results of a Cochrane review indicated that the use of heparin in patients with cancer but with no therapeutic or prophylactic indication for it was related to a significant reduction in death at 24 months but not at 12 months. [31] A statistically and clinically important reduction in VTE was also noted. It had no effect on bleeding or quality of life. Future studies are needed to investigate the survival benefit of different types of anticoagulants in patients with different types and stages of cancer.

No significant reduction in mortality at 6 months, 1 year, 2 years, or 5 years was found in another, similar Cochrane review comparing the use of oral anticoagulants with either placebo or no intervention in patients with cancer who had no therapeutic or prophylactic indication for anticoagulation. In addition, the oral anticoagulant warfarin was found to increase major and minor bleeding. [32]

In a study of patients with a first VTE who did not have cancer and who received different durations of anticoagulant treatment, the results indicated a similar risk of recurrent VTE whether anticoagulation therapy was stopped after 3 months or a longer period of treatment was provided. The study evaluated data from seven randomized trials that included 2925 men or women. Proximal deep vein thrombosis (DVT) and PE showed a higher risk of recurrence whenever treatment was stopped. [33]

Results from phase II/III studies, according to a report by Merli et al, suggested that newer oral anticoagulants may provide an efficacious alternative for prevention of VTE in orthopedic surgery and have had a good overall safety profile, with no evidence of increased hepatotoxicity. Comparison with large observational registries, however, revealed differences between real-life patient populations; differences in endpoint definitions also prevented indirect comparison of agents. [34]

The study’s authors stated that specific compliance and postmarketing safety issues (especially liver enzyme monitoring requirements) need to be clarified before these agents can be widely accepted in routine clinical practice.


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