Anticoagulation for the initial treatment of venous thromboembolism in patients with cancer

Abstract

BACKGROUND.The authors compared the relative efficacy and safety of low‐ molecular‐weight heparin (LMWH) and unfractionated heparin (UFH) for the initial treatment of venous thromboembolism (VTE) between patients with and without cancer.METHODS.By using Cochrane methodology for systematic reviews, separate meta‐analyses were conducted for subgroups of patients with and without cancer, and relative risks (RRs) were compared for statistical significance. The methodologic quality for each outcome was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation approach.RESULTS.LMWH reduced mortality significantly compared with UFH in patients with cancer (RR of 0.71; 95% confidence interval [95% CI], 0.52‐0.98 [moderate‐quality evidence]) but not in patients without cancer (RR of 0.97; 95% CI, 0.65‐1.46 [low‐quality evidence]). However, the difference in the RR for the 2 subgroups did not reach statistical significance (P = .113). The difference between LMWH and UFH in the effect on recurrent VTE was not statistically significant in the subgroup with cancer (RR of 0.78; 95% CI, 0.29‐2.08 [low‐quality evidence]), in the subgroup without cancer (RR of 0.94; 95% CI, 0.60‐1.46 [low‐quality evidence]), or between the 2 subgroups (P = .367). No data were available for bleeding outcomes, thrombocytopenia, or postphlebitic syndrome.CONCLUSIONS.The current results indicated that LMWH most likely is superior to UFH in reducing mortality in the initial treatment of VTE for patients with cancer. There is a need for more and better designed trials to confirm these findings. Cancer 2008. © 2008 American Cancer Society.

Platelets increase survival of adenocarcinoma cells challenged with anticancer drugs: mechanisms and implications for chemoresistance

“…The first evidence for the association between vascular thrombosis and cancer was presented in 1865 when the French physician Armand Trousseau reported a high incidence of venous thrombosis in patients with gastric carcinomas. Recent clinical and experimental data confirm the relationship between cancer and thrombosis as epidemiological studies showed that 2 out of 10 cancer patients may develop thrombotic complications during the clinical course of their disease (Akl et al ., 2008a,b).…”

Anticoagulation in the management of venous thromboembolism in the cancer patient

“…However, it is exclusively renally cleared so it cannot be given to patients with a creatinine clearance less than 30 ml/min and is not protamine reversible [40]. A [41]. Equivalent mortality was noted in studies comparing UFH and LMWH with fondaparinux [42][43][44].…”

The Antithrombotic Potential of Tinzaparin and Enoxaparin Upon Thrombin Generation Triggered In Vitro by Human Ovarian Cancer Cells IGROV1

“…They are used as prophylactic doses in patients with cancer at high risk for VTE. [18][19][20] Thus, the comprehension of the mechanism of action of these LMWHs in cancer-induced hypercoagulability is a prerequisite for the optimization of the antithrombotic treatment. For this purpose, an experimental system for the modelization of hypercoagulability induced by cancer cells and the influence of the latter on the antithrombotic efficiency of LMWHs, fondaparinux, and the direct orally active anticoagulants has been developed and validated.…”