title: Thrombosis, cancer and renal insufficiency: low molecular weight heparin at the crossroads.
abstract: BACKGROUND
  Venous thromboembolism (VTE) and renal insufficiency are common in cancer patients. Prompt treatment is necessary to reduce the high rates of VTE-related mortality and morbidity. VTE prophylaxis is underused in cancer patients. We review current recommendations for the treatment and prevention of VTE in cancer patients and discuss low molecular weight heparin (LMWH) use in cases of renal failure.
  
  
  METHODS
  This study is a retrospective literature review.
  
  
  RESULTS
  There are few published recommendations for LMWH use in cancer patients with renal insufficiency. Treatment guidelines largely follow recommendations for other patients with renal failure. Enoxaparin therapy is complicated by the need for regular monitoring of renal function and anti-Xa levels and for dosage adjustment to prevent bleeding. Few data are available to support the systematic use of dalteparin. Tinzaparin is least likely to bioaccumulate in patients with renal failure.
  
  
  CONCLUSIONS
  VTE is the second most common cause of death in cancer patients. Renal insufficiency is present in 50-60 % of cancer patients. Data from renal patients suggest that tinzaparin may be safe and effective for VTE treatment and prevention in cancer patients with renal failure.
authors.affiliation: Department of Medical Oncology, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Scotté
authors.forename: J B
authors.initials: JB
authors.lastname: Rey
authors.forename: V
authors.initials: V
authors.lastname: Launay-Vacher
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D017410:Practice Guidelines as Topic; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D054556:Venous Thromboembolism / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight