Venous thromboembolism risk and management in women with cancer and thrombophilia.
BACKGROUND
Venous thromboembolism (VTE) and its complications result in a high rate of morbidity and mortality.


OBJECTIVE
The aim of this study was to review the risk of VTE in women with cancer and other predisposing risk factors, as well as the management of these patients.


METHODS
Data for this review were identified by searches of MEDLINE, Current Contents, and references from relevant articles using the search terms venous thrombosis, venous thromboembolism, pulmonary embolism, anticoagulation, risk factors, cancer, thrombophilia, heparin, and warfarin. Abstracts and reports from meetings were included only when they directly related to previously published work. Only papers published in English between 1960 and 2005 were included.


RESULTS
VTE risk is increased in patients with cancer, with 15% of these patients developing VTE or disseminated intravascular coagulation. Understanding a patient's thromboembolic risk is essential because it affects the type and duration of antithrombotic therapy. The incidence of VTE is dependent on a number of factors, including tumor type, mode of treatment, surgical procedures, patient immobility, and thrombophilia. Progression and recurrence of VTE can be prevented by therapy with unfractionated or low-molecular-weight heparin (LMWH_ followed by warfarin for at least three months. In selected women with advanced cancer disease, a long-term course of LMWH in therapeutic doses is the treatment of choice.


CONCLUSIONS
In women with cancer, the clinical course is often complicated by VTE episodes. The risk of VTE increases in association with either inherited or acquired thrombophilic conditions. Appropriate management of throemboembolism in women with cancer has the potential to reduce the negative clinical outcomes related to these complications.
Department of Medical and Surgical Sciences, 2nd Chair of Internal Medicine, Padua, Italy. paoloprandoni@tin.it
Paolo
P
Prandoni
D015897:Comorbidity; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D009369:Neoplasms / Q000453:epidemiology*; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000453:epidemiology*; D012307:Risk Factors; D012308:Risk Management; D019851:Thrombophilia / Q000453:epidemiology*; D020246:Venous Thrombosis / Q000188:drug therapy / Q000453:epidemiology*; D016387:Women's Health
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight