Long-term use of daily subcutaneous low molecular weight heparin in cancer patients with venous thromboembolism: why hesitate any longer?
BACKGROUND
Cancer disease inducing an acquired hypercoagulable state is a well-established feature. Venous thromboembolism (VTE) occurs in 4% to 20% of the patients and is the second cause of mortality in cancer; VTE incidence is four to six times higher in cancer patients compared to other patients. In the last 10 years, important randomised clinical trials have clearly demonstrated that long-term use of daily subcutaneous low molecular weight heparin (LMWH) is more efficient than Vitamin K antagonists to treat VTE in cancer patients. First Italian, then American and more recently French national guidelines recommend the use of LMWH for 3 to 6 months for curative treatment of VTE in cancer patients with a clearly high level (A) of evidence. Despite convincing data, many physicians have not yet modified their clinical practice, doubting the tolerability of such a long period of subcutaneous injections. In fact, LMWH long-term use appears well tolerated and may also increase cancer patient survival.


OBJECTIVE
The aim of this review is to present the scientific rationale for long-term daily subcutaneous LMWH in cancer patients, and to reinforce the favourable benefit/tolerance tolerability ratio with this specific antithrombotic strategy.
Debourdeau
Philippe
P
Internal Medicine and Oncology Department, Desgenettes Military Hospital, 108 Bvd Pinel, 69275, Lyon cedex 3, France. pdebourdeau@yahoo.fr
Elalamy
Ismail
I
de Raignac
Axelle
A
Meria
Paul
P
Gornet
Jean Marc
JM
Amah
Yahovi
Y
Korte
Wolfang
W
Marty
Michel
M
Farge
Dominique
D
D002986:Clinical Trials as Topic; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D007279:Injections, Subcutaneous; D009369:Neoplasms / Q000150:complications*; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000209:etiology
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight