Prophylactic and Therapeutic Anticoagulation for Thrombosis-Major Issues in Oncology

Marc Carrier; Agnes YY Lee

Disclosures

Nat Clin Pract Oncol. 2009;6(2):74-84. 

In This Article

Summary and Introduction

Summary

Venous thromboembolism (VTE) is a major cause of morbidity and mortality in patients with cancer. Primary prevention with pharmacologic agents (or mechanical methods, if anticoagulants are contraindicated) is recommended in all cancer patients hospitalized for surgical or medical reasons. The role of prophylaxis in outpatients is less certain because of the diversity of the patient populations and their cancer treatments with respect to the associated risks of VTE and bleeding. Treatment with low-molecular weight heparin is the recommended first-line approach in cancer patients with newly diagnosed VTE, and is usually continued for a minimum of 3-6 months. Other management issues that require further research include the optimum duration of anticoagulant therapy, the treatment of recurrent VTE, the role of vena cava filters, the effects of VTE and its treatment on quality of life, and the impact of anticoagulants on survival. Newer anticoagulants hold promise in providing more-effective and convenient treatment of VTE in this high-risk population, but further studies are awaited.

Introduction

Thromboembolic events, which include deep vein thrombosis (DVT) and pulmonary embolism (PE), are one of the leading causes of death in patients with cancer.[1] Patients with malignancy not only have a four-fold increased risk of developing venous thromboembolism (VTE),[2] they also have a three-fold risk of recurrent VTE and a three-fold to six-fold risk of major bleeding while receiving anticoagulant treatment with warfarin, relative to the general population.[3,4,5] Furthermore, thrombotic complications can delay or interfere with first-line anticancer therapy, precipitate or prolong hospitalization, and consume health care resources. Effective thromboprophylaxis and appropriate treatment of VTE are important strategies for minimizing morbidity and mortality and potentially increase patient quality of life and reduce health care costs.

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