title: Low molecular weight heparin and cancer survival: clinical trials and experimental mechanisms.
abstract: BACKGROUND
  The relationship between cancer and thrombosis is complex, as the hemostatic system is inextricably linked to the mechanisms of cancer growth and metastasis. The coagulation system thus appears to be a site for oncogenic events and necessary for the survival and spread of malignant cells. Although several meta-analyses on the effectiveness of unfractionated heparin and low molecular weight heparin (LMWH) in the treatment of venous thromboembolism (VTE) have suggested a lower mortality risk in cancer patients receiving LMWH, this contention has not received general acceptance. In fact, there exist no sufficiently powered studies to date supporting the routine use of LMWH to improve cancer survival. Meanwhile, the molecular mechanism underlying the anti-neoplastic effect of LMWH which is independent of its anti-coagulant function is largely unexplored and is a topic of active investigation.
  
  
  METHODS
  In this communication, we aimed to review comprehensively evidences from clinical trials, meta-analysis as well as experimental molecular research and to identify future research areas of importance so as to stimulate future research on the potential anti-tumor action of LMWH.
  
  
  CONCLUSIONS
  Although benefit of LMWH on cancer patients' survival is controversial depending on the tumor type, cancer stage as well as LMWH type, it appears to be associated with a reduction in VTE and increased bleeding is minor and controllable; thus, randomized controlled trials targeting the survival benefit of certain specific LWMH are needed and justified, and more in-depth experimental researches are imperative to elucidate the anti-tumor effect of anticoagulants.
authors.affiliation: Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China. ningning1723@126.com.|Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, 200127, China. ningning1723@126.com.
authors.forename: Ning
authors.initials: N
authors.lastname: Zhang
authors.affiliation: Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China.|Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, 200127, China.
authors.forename: Weihua
authors.initials: W
authors.lastname: Lou
authors.affiliation: Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China.|Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, 200127, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Ji
authors.affiliation: Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China.|Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, 200127, China.
authors.forename: Lihua
authors.initials: L
authors.lastname: Qiu
authors.affiliation: Macau Institute for Applied Research in Medicine and Health3, State Key laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao. btsang@ohri.ca.|Department of Obstetrics & Gynecology and Cellular & Molecular Medicine, Interdisciplinary School of Health Sciences, University of Ottawa, and Chronic Diseases Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. btsang@ohri.ca.
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Tsang
authors.affiliation: Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China. diwen163@163.com.|Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, 200127, China. diwen163@163.com.
authors.forename: Wen
authors.initials: W
authors.lastname: Di
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D002986:Clinical Trials as Topic; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D015996:Survival Rate; D054556:Venous Thromboembolism / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight
keywords: Cancer; Low molecular weight heparin; Molecular mechanisms; Randomized trial; Survival