[Venous tromboembolic treatment in patients with cancer].
OBJECTIVE
Venous tromboembolic treatment in patients with cancer can be a clinical dilemma. Comorbid conditions, significant risk of recurrence of bleeding associated with warfarin, difficult venous access, are some of the factors that often complicate anticoagulants therapy in patients with cancer.


METHODS
Low molecular weight heparin has replaced unfractionated heparin as the first line treatment in the majority of patients with venous thromboembolism and cancer, in hospital or safely at home. Recent trial demonstrated that long-term low molecular weight heparin administrated over a 6-month period reduced the rate of recurrence venous thromboembolism with non increase in bleeding compared with oral anticoagulant therapy. Placement of an inferior vena caval filter should be reserved for patients with active or very high risk of bleeding, but oncologist should consider these sobering results in such patients. Whether anticoagulants might also improve cancer survival rates independent of their effect on thromboembolism deserves further investigation.


CONCLUSIONS
In future, new antithrombotic agents such as oral direct thrombin or long-acting synthetic factor Xa inhibitor may be useful in these patients.
Lévesque
H
H
Département de médecine interne, CHU de Rouen-Boisguillaume,76031 Rouen, cedex, France. herve.levesque@chu-rouen.fr
Belizna
C
C
Michel
P
P
Pfister
C
C
D006801:Humans; D009369:Neoplasms / Q000150:complications*; D012307:Risk Factors; D013923:Thromboembolism / Q000150:complications* / Q000628:therapy*; D020246:Venous Thrombosis / Q000150:complications* / Q000628:therapy*