Low-Molecular-Weight Heparin or Oral Anticoagulation for Secondary Prevention of Deep Vein Thrombosis in Cancer Patients

ABSTRACT

Thrombosis in the cancer patient is a unique problem. Cancer patients with acute venous thromboembolism are at increased risk of its recurrence compared with noncancer patients. Cancer patients are also at increased risk of anticoagulant-associated bleeding compared with noncancer patients. Finally, many cancer patients have a compromised quality of life and recurrent thrombosis has an additional negative impact on them.

In order to optimize treatment of acute venous thromboembolism in cancer patients, the following outcomes must be considered: a reduction in the rate of recurrent venous thromboembolism, a reduction in the risk of bleeding compared to that seen with current anticoagulant treatment regimens, and a positive impact on the quality of life of the patient.

Cancer - low-molecular-weight heparin - thromboembolism

REFERENCES

• 1 Hutten B A, Prins M H, Gent M, Ginsberg J, Tijssen J G, Büller H R. Incidence of recurrent thromboembolic and bleeding complications among patients with venous thromboembolism in relation to both malignancy and achieved international normalized ratio: a retrospective analysis.  J Clin Oncol . 2000;  18 3078-3083
• 2 Prandoni P. Antithrombotic strategies in patients with cancer.  Thromb Haemost . 1997;  78(suppl) 141-144
• 3 Gould M K, Dembitzer A D, Doyle R L, Hastie T J, Garber A M. Low-molecular-weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis. A meta-analysis of randomized, controlled trials.  Ann Intern Med . 1999;  130 800-809
• 4 Levine M, Gent M, Hirsh J. et al . A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis.  N Engl J Med . 1996;  334 677-681
• 5 Koopman M M, Prandoni P, Piovella F. et al . Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. The Tasman Study Group.  N Engl J Med . 1996;  334 682-687
• 6 Low-molecular-weight heparin in the treatment of patients with venous thromboembolism. The Columbus Investigators.  N Engl J Med . 1997;  337 657-662
• 7 Pini M, Aiello S, Manotti C. et al . Low molecular weight heparin versus warfarin in the prevention of recurrences after deep vein thrombosis.  Thromb Haemost . 1994;  72 191-197
• 8 Das S K, Cohen A T, Edmondson R A, Melissari E, Kakkar V V. Low-molecular-weight heparin versus warfarin for prevention of recurrent venous thromboembolism: a randomized trial.  World J Surg . 1996;  20 521-526
• 9 Lopaciuk S, Bielska-Falda H, Noszczyk W. et al . Low molecular weight heparin versus acenocoumarol in the secondary prophylaxis of deep vein thrombosis.  Thromb Haemost . 1999;  81 26-31
• 10 Gonzalez-Fajardo J A, Arreba E, Castrodeza J. et al . Venographic comparison of subcutaneous low-molecular-weight heparin with oral anticoagulant therapy in the long-term treatment of deep venous thrombosis.  J Vasc Surg . 1999;  30 283-292
• 11 Veiga F, Escriba A, Maluenda M P. et al . Low molecular weight heparin (enoxaparin) versus oral anticoagulant therapy (acenocoumarol) in the long-term treatment of deep venous thrombosis in the elderly: a randomized trial.  Thromb Haemost . 2000;  84 559-564
• 12 Hull R, Pineo G, Mah A. Long-term low molecular weight heparin treatment versus oral anticoagulant therapy for proximal deep vein thrombosis (abst).  Blood . 2000;  96 449
• 13 Meyer G, Marjanovic Z, Valcke J, Lorcerie B. Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer.  Arch Intern Med . 2002;  162 1729-1735
• 14 Hull R D, Pineo G F, Mah A F, Brant R F, for the LITE study investigators. A randomized trial evaluating long-term low molecular weight heparin therapy for three months versus intravenous heparin followed by warfarin sodium (abst).  Blood . 2002;  100 556
• 15 Lee A Y, Levine M N, Baker R I, Bowden C. A randomized trial of long term dalteparin low molecular weight heparin versus oral anticoagulant therapy in cancer patients with venous thromboembolism.  N Engl J Med . 2003;  349 146-153