title: Treatment and secondary prevention of venous thromboembolism in cancer.
abstract: Patients with cancer who develop venous thromboembolism (VTE) are at elevated risk for recurrent thrombotic events, even during anticoagulant therapy. The clinical picture is further complicated because these patients are also at increased risk of bleeding while on anticoagulants. In general, there are four key goals of treatment for VTE: preventing fatal pulmonary embolism (PE); reducing short-term morbidities associated with acute leg or lung thrombus; preventing recurrent VTE; and preventing the long-term sequelae of VTE (e.g., post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension). A fifth goal - minimising the risk for bleeding while on anticoagulation - is particularly warranted in patients with cancer. Traditionally, pharmacological treatment of VTE has two phases, with the transition between phases marked by a switch from a rapid-acting, parenterally administered anticoagulant (such as unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), or fondaparinux) to an oral vitamin K antagonist (e.g., warfarin). Recent clinical trials of established agents and the advent of new pharmacological options are changing this paradigm. Low-molecular-weight heparin continued for 6 months is more effective than warfarin in the secondary prevention of VTE in cancer patients without increasing the risk of bleeding and is now the preferred treatment option. Given the impact of VTE on short-term and long-term outcomes in patients with cancer, a group of health-care providers based in the United Kingdom gathered in London in 2009 to discuss recent data on cancer-associated thrombosis and to evaluate how these recommendations can be integrated or translated into UK clinical practice. This article, which is the third of four articles covering key topics in cancer thrombosis, focuses on treatment and secondary prevention of VTE in cancer patients.
authors.affiliation: Academic Unit of Clinical Oncology, Cancer Research Centre, Weston Park Hospital, Whitham Road, Sheffield S10 2SJ, UK. R.E.Coleman@sheffield.ac.uk
authors.forename: R
authors.initials: R
authors.lastname: Coleman
authors.forename: P
authors.initials: P
authors.lastname: MacCallum
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000009:adverse effects; D005374:Filtration; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D017211:Treatment Failure; D054556:Venous Thromboembolism / Q000517:prevention & control / Q000628:therapy*
chemical_list: D000925:Anticoagulants
references.citation: Br J Haematol. 2006 Aug;134(4):357-65
references.pmid: 16822286
references.citation: Lancet. 1960 Jun 18;1(7138):1309-12
references.pmid: 13797091
references.citation: Cochrane Database Syst Rev. 2004 Oct 18;(4):CD001100
references.pmid: 15495007
references.citation: Medicine (Baltimore). 1999 Sep;78(5):285-91
references.pmid: 10499070
references.citation: N Engl J Med. 1992 Nov 19;327(21):1485-9
references.pmid: 1406880
references.citation: Thromb Res. 2009 Apr;123(6):837-44
references.pmid: 18977517
references.citation: Thromb Haemost. 2009 Apr;101(4):762-9
references.pmid: 19350123
references.citation: Chest. 2008 Jun;133(6 Suppl):454S-545S
references.pmid: 18574272
references.citation: J Support Oncol. 2006 Mar;4(3):115-20
references.pmid: 16553136
references.citation: Blood. 2002 Nov 15;100(10):3484-8
references.pmid: 12393647
references.citation: N Engl J Med. 1995 Jun 22;332(25):1661-5
references.pmid: 7760866
references.citation: J Thromb Haemost. 2009 May;7(5):760-5
references.pmid: 19245418
references.citation: Arch Intern Med. 2002 Aug 12-26;162(15):1729-35
references.pmid: 12153376
references.citation: N Engl J Med. 2003 Jul 10;349(2):146-53
references.pmid: 12853587
references.citation: J Clin Oncol. 2007 Dec 1;25(34):5490-505
references.pmid: 17968019
references.citation: Circulation. 2008 Apr 1;117(13):1711-6
references.pmid: 18347212
references.citation: Arch Intern Med. 2004 Aug 9-23;164(15):1653-61
references.pmid: 15302635
references.citation: J Thromb Haemost. 2006 Sep;4(9):1950-6
references.pmid: 16961602
references.citation: J Thromb Haemost. 2007 Mar;5(3):632-4
references.pmid: 17319909
references.citation: Ann Intern Med. 2004 Feb 3;140(3):175-83
references.pmid: 14757615
references.citation: Br J Haematol. 2006 Sep;134(6):590-5
references.pmid: 16869824
references.citation: J Natl Compr Canc Netw. 2006 Oct;4(9):903-10
references.pmid: 17020668
references.citation: J Thromb Haemost. 2006 Mar;4(3):529-35
references.pmid: 16460435
references.citation: Circulation. 2004 Aug 10;110(6):744-9
references.pmid: 15262836
references.citation: N Engl J Med. 2003 Oct 30;349(18):1695-702
references.pmid: 14585937
references.citation: Lancet Oncol. 2008 Jun;9(6):577-84
references.pmid: 18510989
references.citation: Arch Intern Med. 2008 Jun 23;168(12):1261-9
references.pmid: 18574082
references.citation: Lancet. 1997 Mar 15;349(9054):759-62
references.pmid: 9074574
references.citation: Hematology Am Soc Hematol Educ Program. 2007;:165-71
references.pmid: 18024625
references.citation: Eur Heart J. 2008 Sep;29(18):2276-315
references.pmid: 18757870
references.citation: Thromb Haemost. 2008 Sep;100(3):435-9
references.pmid: 18766259
references.citation: Ann Intern Med. 2004 Jun 1;140(11):867-73
references.pmid: 15172900
references.citation: N Engl J Med. 1979 Oct 18;301(16):855-8
references.pmid: 384248
references.citation: Circulation. 2005 Jul 19;112(3):416-22
references.pmid: 16009794
references.citation: Thromb Haemost. 2008 Jul;100(1):26-31
references.pmid: 18612534