Prophylactic anti-coagulation in cancer palliative care: a prospective randomised study.
OBJECTIVE
The objective of this study was to determine utility of prophylactic anti-coagulation in cancer patients hospitalised for palliative care in a specialised centre.


METHODS
Prospective 1:1 open randomised study was designed. Twenty patients aged 55 to 88 years with advanced cancer and an estimated life expectancy of less than 6 months were assigned to either receive treatment with 2,850/3,800 U (<70/>70 kg) of daily subcutaneous nadroparin or no treatment. Suspicion of venous thrombo-embolism (deep vein thrombosis and pulmonary embolism) was confirmed by echo-Doppler examination of the lower limbs and/or by spiral computed tomography scan of the lungs. Bleeding episodes were recorded. Platelet count was measured on days 7 and 14. Survival time from study entry was determined.


RESULTS
One venous thrombo-embolism and one major bleeding occurred in the group receiving nadroparin, whereas two minor bleedings occurred in the control group. At 3 months, nine of ten participants had died in the control group vs five of ten in the group receiving nadroparin (P = 0.141). Five participants could be discharged home (P = 0.141).


CONCLUSIONS
Decision to administer prophylactic nadroparin in hospitalised cancer patients under palliative care remains a challenge. Better mobility score at admission and the likelihood to be discharged home may be useful for practical purposes. The observation of a potential influence of prophylactic nadroparin on survival deserves further studies.
Weber
Catherine
C
Department of Rehabilitation and Geriatrics, Service of Palliative Medicine Cesco, University Hospitals of Geneva, 11 chemin de la Savonnière, 1245, Collonge-Bellerive, Switzerland.
Merminod
Thierry
T
Herrmann
François R
FR
Zulian
Gilbert B
GB
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017762:Nadroparin / Q000627:therapeutic use*; D009369:Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D013534:Survival; D014463:Ultrasonography; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging / Q000517:prevention & control*
D000925:Anticoagulants; D017762:Nadroparin