Managing cancer-related venous thromboembolic disease: low-molecular-weight heparins and beyond

Abstract

Venous thromboembolism is a major contributor to the morbidity and mortality of patients with cancer. For patients undergoing cancer surgery, several trials support the safety and efficacy of unfractionated heparin and of low-molecular-weight heparin for the prevention of venous thromboembolism, while data regarding the efficacy and safety of these agents in the setting of medical hospitalization is less definitive and must be extracted from trials including noncancer patients with different thrombotic risk factors. Randomized clinical studies confirm that patients with cancer who develop venous thromboembolism have superior outcomes when treated with long-term low-molecular-weight heparin as compared with warfarin. Novel anticoagulants that are orally bioavailable and function by directly inhibiting factor Xa or thrombin are entering the market. To date, data regarding the efficacy and safety of these novel anticoagulants as venous thromboembolism prophylaxis and treatment in cancer patients are not available and must be extracted from larger trials with heterogeneous patient populations.

Keywords::

• anticoagulation
• anti-IIa
• anti-Xa
• cancer
• heparin
• low-molecular-weight heparin
• malignancy
• survival
• thrombosis
• venous thromboembolism

Financial & competing interests disclosure

C O'Connell has received honoraria from Pharmion. H Lieberman has received research funding from: Sanofi–Aventis, Pharmion, Bristol–Myers–Squibb and Pfizer. H Lieberman is also a consultant from Sanofi–Aventis, Pfizer and Bristol–Myers–Squibb. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.