Semin Thromb Hemost 2002; 28(s3): 019-024
DOI: 10.1055/s-2002-34071
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Venous Thromboembolism in Cancer Patients: Expanding Horizons

David Bergqvist
  • Department of Surgery, Akademiska Sjukhuset, Uppsala University, 75185 Uppsala, Sweden
Further Information

Publication History

Publication Date:
16 September 2002 (online)

ABSTRACT

Venous thromboembolism (VTE) and particularly idiopathic VTE may be paraneoplastic phenomena. The merits of screening patients with idiopathic VTE for occult cancer are still under debate, and randomized studies are required to establish its potential cost-effectiveness. Cancer and its related surgery greatly increase the risk of VTE. Thromboprophylaxis using agents such as low-molecular-weight heparin (LMWH) has proved to be safe and effective in reducing the incidence of postoperative VTE. The ENOXACAN II study has shown that prolonging the standard 1-week regimen of the LMWH enoxaparin to 4 weeks may further reduce the incidence of postoperative VTE. Enoxaparin has also shown potential benefits in the secondary prevention of VTE and the reduction of bleeding complications. Emerging data indicate that LMWH may improve survival rates in cancer patients with VTE, making this a very important area for future research.

REFERENCES

  • 1 Trousseau A. Phlegmasia alba dolens. In: Clinique Médicale de l'Hôtel-Dieu de Paris Paris: Ballière 1865 : 654-712
  • 2 Nordström M, Lindblad B, Anderson H, Bergqvist D, Kjellstrom T. Deep venous thrombosis and occult malignancy: an epidemiological study.  Br Med J . 1994;  308 891-894
  • 3 Pritchard K I, Paterson A HG, Paul N A. Increased thromboembolic complications with concurrent tamoxifen and chemotherapy in a randomized trial of adjuvant therapy for women with breast cancer.  J Clin Oncol . 1996;  14 2731-2737
  • 4 Flordal P A, Bergqvist D, Burmark U S, Ljungstrom K G, Torngren S, for the Fragmin Multicentre Study Group. Risk factors for major thromboembolism and bleeding tendency after elective general surgical operations.  Eur J Surg . 1996;  162 783-789
  • 5 Geerts W H, Heit J A, Clagett G P. Prevention of venous thromboembolism.  Chest . 2001;  119(Suppl 1) 132S-175S
  • 6 Gallus A, Cade J, Ockelford P, for the ANZ-Organon Investigators' Group et al. Orgaran (Org 10172) or heparin for preventing venous thrombosis after elective surgery for malignant disease?.  <~>A double-blind, randomised, multicentre comparison. Thromb Haemost . 1993;  70 562-567
  • 7 ENOXACAN Study Group. Efficacy and safety of enoxaparin versus unfractionated heparin for prevention of deep vein thrombosis in elective cancer surgery: a double-blind randomized multicentre trial with venographic assessment.  Br J Surg . 1997;  84 1099-1103
  • 8 Bergqvist D, Burmark U S, Flordal P A. Low molecular weight heparin started before surgery as prophylaxis against deep vein thrombosis: 2500 versus 5000 XaI units in 2070 patients.  Br J Surg . 1995;  82 496-501
  • 9 Bergqvist D, Benoni G, Bjorgell O. Low-molecular-weight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement.  N Engl J Med . 1996;  335 696-700
  • 10 Dahl O E, Andreassen G, Aspelin T. Prolonged thromboprophylaxis following hip replacement surgery-results of a double-blind, prospective, randomised, placebo-controlled study with dalteparin (Fragmin®).  Thromb Haemost . 1997;  77 26-31
  • 11 Planes A, Vochelle N, Darmon J Y. Risk of deep-vein thrombosis after hospital discharge in patients having undergone total hip replacement: double-blind randomised comparison of enoxaparin versus placebo.  Lancet . 1996;  348 224-228
  • 12 Lassen M R, Borris L C, Anderson B S. Efficacy and safety of prolonged thromboprophylaxis with a low molecular weight heparin (dalteparin) after total hip arthroplasty-The Danish Prolonged Prophylaxis (DaPP) Study.  Thromb Res . 1998;  89 281-287
  • 13 Hull R D, Pineo G F, Francis C. Low-molecular-weight heparin prophylaxis using dalteparin extended out-of-hospital vs in-hospital warfarin/out-of-hospital placebo in hip arthroplasty patients. A double-blind, randomized comparison.  Arch Intern Med . 2000;  160 2208-2215
  • 14 Bergqvist D, Agnelli G, Cohen A T, for the ENOXACAN II investigators et al. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer.  N Engl J Med . 2002;  346 975-980
  • 15 Prandoni P, Piccioli A. Venous thromboembolism and cancer: a two-way clinical association.  Front Biosci . 1997;  1 12-20
  • 16 Gruel Y, Meyer G, Marjanovic Z. Canthanox, a randomised controlled study comparing low-molecular-weight heparin and warfarin for the prevention of recurrent venous thromboembolism in patients with cancer. Presented at the ASH annual meeting, December 2001, Orlando, Florida (Abst 2956)
  • 17 Dolovich L R, Ginsberg J S, Douketis J D, Holbrook A M, Cheah G. A meta-analysis comparing low-molecular-weight heparins with unfractionated heparin in the treatment of venous thromboembolism: examining some unanswered questions regarding location of treatment, product type, and dosing frequency.  Arch Intern Med . 2000;  160 181-188
    >