Should Patients with Venous Thromboembolism and Cancer Be Treated Differently?

Abstract

Patients with malignant disease constitute a significant subgroup among patients with venous thromboembolism. Current results suggest that cancer patients are not only at an increased risk for thromboembolic events, particularly during chemotherapy treatment or after surgery, they also have an increased risk for bleeding complications while receiving oral anticoagulant treatment. The exact incidences of venous thromboembolic complications for the various types of cancer, however, are not well determined. Recent studies have indicated that subcutaneous low-molecular-weight heparin (LMWH) is as safe and effective as intravenous unfractionated heparin (UFH) in the initial treatment of venous thromboembolism. Moreover, a meta-analysis has provided preliminary evidence that, compared with UFH, LMWH treatment may prolong survival in cancer patients. Initiation of LMWH treatment in these patients is, therefore, recommended. Prospective randomized clinical trials to assess the optimum dose and duration of therapy are called for.

Comparison of Low-Molecular-Weight Heparin and Warfarin for the Secondary Prevention of Venous Thromboembolism in Patients With Cancer

“…The high failure rate of long-term oral anticoagulant treatment in patients with venous thromboembolism and cancer suggests that alternative treatments should be evaluated, and it has been suggested that long-term lowmolecular-weight heparin use may be superior to oral anticoagulants in these patients. 2,17 The results of the present study support this hypothesis, suggesting that a full dose of enoxaparin is at least as effective as and may be safer than warfarin for the long-term treatment of venous thromboembolism in cancer patients. Since initial anticoagulant treatment was short and did not differ between the 2 groups, the results may not be explained by differences in the initial prestudy treatment or by the site and extension of the underlying cancer, which were also well balanced between the 2 groups.…”

“…is a frequent complication of active malignancy and has been repeatedly identified as a marker of poor outcome in patients with cancer. [1][2][3] Patients with cancer and venous thromboembolism have a 3-fold lower survival at 1 year than patients with cancer who do not have venous thromboembolism. 3 The increased mortality rate observed in cancer patients with venous thromboembolism may result from a more advanced cancer state 3 but can also be related to venous thromboembolism itself, which is difficult to treat in these patients.…”

Colon cancer metastasis in mouse liver is not affected by hypercoagulability due to Factor V Leiden mutation

“…Cancer patients are at an increased risk of developing venous thromboembolism (VTE) as compared with the general population [1,2]. Cancer itself can induce a hypercoagulable state by pressure on veins, damage of vessel walls and by direct or indirect activation of the coagulation system [3].…”

Thromboembolic Disorders in Cancer

“…Clinical trials have demonstrated that LMWH reduces the risk of recurrent VTE, decreases the risk of major bleeds associated with UFH, and may offer a survival benefit in patients with cancer (Dolovich, Ginsberg, Douketis, Holbrook, & Cheah, 2000;Leizorovicz, 1996;Lensing, Prins, Davidson, & Hirsh, 1995;Smorenburg, Hutten, & Prins, 1999). Based on these findings, the ACCP Consensus Conference recommended the use of LMWH over UFH (Hyers et al, 2001).…”