Management of refractory venous thrombosis associated with malignancy using a supra-therapeutic enoxaparin regimen

Cunningham, Moya; Gilmore, Ruth; O’Donnell, Dearbhaile M.; O’Donnell, James S.

doi:10.1007/s11845-008-0200-9

Cited by 7 publications

(4 citation statements)

References 5 publications

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“…It is currently unknown whether dose escalation of LMWH would be effective and safe for treating recurrent VTE in cancer patients already on LMWH. One case report has described successful management of recurrent VTE in a patient with cervical cancer using a supratherapeutic dose of LMWH [16].…”

Section: Introductionmentioning

confidence: 99%

Dose escalation of low molecular weight heparin to manage recurrent venous thromboembolic events despite systemic anticoagulation in cancer patients

Carrier

Gal

Cho

et al. 2009

Journal of Thrombosis and Haemostasis

206

105

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To cite this article: Carrier M, Le Gal G, Cho R, Tierney S, Rodger M, Lee AY. Dose escalation of low molecular weight heparin to manage recurrent venous thromboembolic events despite systemic anticoagulation in cancer patients. J Thromb Haemost 2009; 7: 760À5. Summary. Background: Cancer patients with venous thromboembolism (VTE) are at high risk of recurrent VTE despite standard anticoagulation. To date, very little published literature is available to guide the treatment of cancer patients with recurrent VTE. Objectives: To evaluate the benefit and risk of low molecular weight heparin (LMWH) dose escalation in cancer patients with recurrent VTE. Patients and methods: This was a retrospective cohort study of consecutive cancer outpatients referred for management of a symptomatic, recurrent VTE while receiving an anticoagulant. Confirmed episodes of recurrent VTE were treated with either dose escalation of LMWH in patients already anticoagulated with LMWH, or initiation of therapeutic dose LMWH in patients who were taking a vitamin K antagonist (VKA). All patients were followed for a minimum of 3 months after the index recurrent VTE unless they died during this period. Results: Seventy cancer patients with a recurrent VTE despite ongoing anticoagulation were included. At the time of the recurrence, 67% of patients were receiving LMWH, and 33% were receiving a VKA. A total of six patients [8.6%; 95% confidence interval (CI) 4.0À17.5%] had a second recurrent VTE during the 3-month follow-up period, at an event rate of 9.9 per 100 patient-years (95% CI 2.0À17.8%). Three patients (4.3%; 95% CI 1.5À11.9%), or 4.8 per 100 patient-years (95% CI 0.0À10.3%) of follow-up, had bleeding complications. The median time between the index recurrent VTE to death was 11.4 months (range, 0À83.9 months). Conclusions: Cancer patients with recurrent VTE have a short median survival. Escalating the dose of LMWH can be effective for treating cases that are resistant to standard, weight-adjusted doses of LMWH or a VKA.

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Section: Introductionmentioning

confidence: 99%

Dose escalation of low molecular weight heparin to manage recurrent venous thromboembolic events despite systemic anticoagulation in cancer patients

Carrier

Gal

Cho

et al. 2009

Journal of Thrombosis and Haemostasis

206

105

View full text Add to dashboard Cite

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“…The use of OLHDE has not been reported frequently in the literature. [15][16][17][18] This report bolsters the evidence base available to providers caring for this unique patient population. The drug manufacturer was contacted and likewise did not have any data available to support this dose.…”

Section: Discussionmentioning

confidence: 76%

Achievement of Therapeutic Anti-Xa Levels in a Proven Heparin-Resistant Patient Through the Use of Nontraditional High-Dose Enoxaparin

et al. 2014

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“…The utility of anti-Xa level monitoring in this situation is unclear. To date there are no studies supporting the use of anti-Xa levels to guide LMWH dosing in the cancer patient and published data is limited to a single case report 37. Further management requires liaison with haematology colleagues for guidance and it is likely that treatment plans will be developed on an individual patient basis.…”

Section: Treatment Of Symptomatic Vtementioning

confidence: 99%

Management of cancer-associated thrombosis in people with advanced disease

Noble

Johnson²

2012

BMJ Support Palliat Care

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The management of venous thromboembolism in the cancer population is clearly established. Low molecular weight heparin has a greater efficacy than warfarin in the treatment of cancer-associated thrombosis and is recommended as the preferred therapy. However, the evidence informing these recommendations excluded patients with poor prognosis or performance status, thrombocytopenia, bleeding or brain metastases. Furthermore, there is limited data on the management of venous thromboembolism resistant to anticoagulation, a phenomenon frequently encountered in the advanced cancer population. This paper will review the management of cancer-associated thrombosis with a particular focus on challenging clinical situations faced by palliative care teams looking after patients with advanced disease.

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Management of refractory venous thrombosis associated with malignancy using a supra-therapeutic enoxaparin regimen

Cited by 7 publications

References 5 publications

Dose escalation of low molecular weight heparin to manage recurrent venous thromboembolic events despite systemic anticoagulation in cancer patients

Dose escalation of low molecular weight heparin to manage recurrent venous thromboembolic events despite systemic anticoagulation in cancer patients

Achievement of Therapeutic Anti-Xa Levels in a Proven Heparin-Resistant Patient Through the Use of Nontraditional High-Dose Enoxaparin

Management of cancer-associated thrombosis in people with advanced disease

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