Can we optimise treatment of thrombosis?
The occurrence of thromboembolism in patients with cancer complicates their management. Patients with cancer who have established venous thrombosis are at increased risk of recurrent venous thromboembolism and anticoagulant-associated bleeding compared with non-cancer patients. Low-molecular-weight heparins have largely replaced unfractionated heparin as the initial treatment for acute thrombosis and have the advantage that they can be administered at home. The use of oral anticoagulant for the long-term secondary prevention of recurrent venous thromboembolism can be problematic in the cancer patient due to unpredictable changes in the dose response because of poor nutrition, infection, concomitant medications and impaired hepatic function. A large randomised clinical trial has shown that 6 months of treatment with the low-molecular-weight heparin dalteparin in place of 6 months of oral anticoagulant therapy significantly reduces the risk of recurrent thrombosis (50% reduction in risk; p = 0.0017) in cancer patients without an increase in bleeding.
Levine
Mark N
MN
Department of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Room 9, 90 Wing, Main Level, Henderson Hospital, 711 Concession Street, L8V 1C3, Hamilton, ON, Canada. mlevine@mcmaster.ca <mlevine@mcmaster.ca>
D000284:Administration, Oral; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors; D020246:Venous Thrombosis / Q000209:etiology* / Q000517:prevention & control*
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight