The role of low-molecular-weight heparins in the prevention and treatment of venous thromboembolism in cancer patients.
Accumulating evidence suggests that low-molecular-weight heparins are the drug of choice for the prevention and treatment of venous thromboembolism in patients with cancer. For prophylaxis in the surgical setting, once-daily subcutaneous injections of low-molecular-weight heparin are as effective and safe as multiple doses of unfractionated heparin. Extending prophylaxis with low-molecular-weight heparins beyond hospitalization was recently found to reduce safely the risk of postoperative thrombosis after abdominal surgery for cancer. For the long-term treatment of deep vein thrombosis and in select patients with pulmonary embolism, recently completed clinical trials have shown that secondary prophylaxis with low-molecular-weight heparin is feasible and more effective than oral anticoagulant therapy in preventing recurrent venous thromboembolism in cancer patients. There is also evidence that low-molecular-weight heparins are effective in cancer patients who develop recurrent thrombosis while on warfarin therapy. Lastly, the potential antineoplastic effects of low-molecular-weight heparins make these agents an attractive option in patients with cancer. Although the management of cancer patients with venous thromboembolism remains challenging, low-molecular-weight heparins have simplified and improved the prevention and treatment of venous thromboembolism in these high-risk patients.
Lee
Agnes Y Y
AY
Department of Medicine, McMaster University, Hamilton, Ontario, Canada. alee@mcmaster.ca
D000925:Anticoagulants / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D013923:Thromboembolism / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight