Anticoagulation for the long term treatment of venous thromboembolism in patients with cancer

Abstract

For the long term treatment of VTE in patients with cancer, LMWH compared to VKA reduces venous thromboembolic events but not death. The decision for a patient with cancer and VTE to start long term LMWH versus oral anticoagulation should balance the benefits and downsides and integrate the patient's values and preferences for the important outcomes and alternative management strategies.

2008 french national guidelines for the treatment of venous thromboembolism in patients with cancer: Report from the working group

“…[67], as well as two Cochrane reviews and metaanalyses on the treatment of VTE in patients with cancer [68,69], have been published. Overall, the conclusions of these studies are concordant with the recommendations proposed by our working group.…”

Long-Term Use of Different Doses of Low-Molecular-Weight Heparin Versus Vitamin K Antagonists in the Treatment of Venous Thromboembolism

“…[19][20][21][22] As observed in the current metaanalysis, the general finding was that for the long-term treatment of VTE in the overall population, LMWH compared to VKA provided no statistically significant benefit in the reduction of VTE recurrence. Our meta-analysis did not indicate that the dose of LMWH in patients without cancer had any influence on the recurrence of symptomatic VTE.…”

“…[19][20][21][22] Until studies that directly compare different LMWH doses for the treatment of VTE are performed, it is impossible to make definitive conclusions about their relative safety and efficacy.…”

Highlights of the American Society of Hematology Meeting 2014: Hemostaseology

“…These recommendations are mainly based on the CLOT trial published in 2003 in which a therapeutic dose of the LMWH dalteparin was compared with warfarin in preventing recurrent thrombosis in patients with cancer [14]. Subsequent studies and a recently published systematic review of the current literature confirmed that LMWH compared with VKA significantly reduces the rate of venous thromboembolism, but not the mortality in cancer patients [15,16].…”