Thrombotic complications – prevention and treatment of venous thromboembolism in cancer patients
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Department of Internal Medicine, Medical University, Lublin, Poland
Children’s Regional Hospital of St Louis, Cracow, Poland
Andrzej Prystupa   

Chair and Department of Internal Medicine, Medical University, Staszica 16, 20-081 Lublin, Poland
J Pre Clin Clin Res. 2012;6(2):84–87
Patients with cancer have an increased risk of venous thromboembolism (VTE). There is evidence that the absolute risk of VTE in cancer patients depends on the type of cancer, stage of disease, treatment with chemotherapy, hormone therapy, immunomodulatory drugs (IMiDs), surgical procedures, the presence of an indwelling central venous catheter (CVC), age, immobilisation and length of anaesthesia. In these patients, risk factors may interact. In addition, cancer patients are at higher risk of recurrent VTE and bleeding than patients without cancer. Thrombotic complications have a significant impact on morbidity and, in some cases, also on mortality of patients with cancer; therefore, thromboprophylaxis to prevent VTE is needed. In some patients, venous thromboembolism may be the earliest symptom of an occult neoplasm. Furthermore, many patients who received a diagnosis of cancer within a year of VTE, already had distant metastases at the time of cancer diagnosis. The literature about the relation between cancer and venous thromboembolism was reviewed, with particular attention to risk factors of VTE in oncological patients, and connections between VTE and diagnosis of occult malignancy. Next, the prevention and treatment of venous thromboembolism in cancer patients is discussed. Finally, a potential anti-tumour and antimetastatic effect of anticoagulation and prognosis of these patients is described. Identifying high risk patients and the application of suitable prevention is the best way to reduce the incidence of VTE and its associated complications.
Kahn SR, Ducruet T, Lamping DL, et al. Prospective evaluation of health-related quality of life in patients with deep venous thrombosis. Arch Intern Med. 2005; 165: 1173-1178.
Piccioli A, Prandoni P. Venous thromboembolism as first manifestation of cancer. Acta Haematol. 2001; 106(1-2): 13-7.
Wun T, White RH. Epidemiology of cancer-related venous thromboembolism. Best Pract Res Clin Haematol. 2009; 22: 9–23.
Heit JA, O’Fallon WM, Petterson TM, et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: apopulation-based study. Arch Intern Med. 2002; 162: 1245-1248.
Michael B. Streiff. Anticoagulation in the management of venous thromboembolism in the cancer patient. J Thromb Thrombolysis. 2011; 31: 282-294.
Venous Thromboembolism and Cancer. Curr Probl Surg. 2007; 44: 157-216.
Elice F, Rodeghiero F. Hematologic malignancies and thrombosis. Thromb Res. 2012; 129: 360-366.
Mandal`a M, Falanga R, Roila F. Management of venous thromboembolism (VTE) in cancer patients. ESMO Clinical Practice Guidelines. Ann Oncol. 2011; 22: 85-92.
Bergqvist D. Venous thromboembolism and cancer: prevention of VTE. Thromb Res. 2001; 102: V209-V213.
Lee AYY, Levine MN. Venous thromboembolism and cancer: risks and outcomes. Circulation. 2003; 107: I17-I21.
Korte W. Cancer and thrombosis: an increasingly important association. Support Care Cancer. 2008; 16: 223-228.
Rodger L, Bick MD. Cancer-associated thrombosis. N Engl J Med. 2003; 349: 109-111.
Piccioli A, Lensing AWA, Prins MH. Extensive screening for occult malignant disease in idiopathic venous thromboembolism: a prospective randomized clinical trial. J Thomb Haemostasis. 2004; 2: 884-889.
Bergqvist D. Venoust hromboembolism and cancer: prevention of VTE. Thromb Res. 2001; 102: V209-V213.
Bergqvist D, Burmark US, Friselli J. Low molecular weight heparin once daily compared with conventional low-dose heparin twice daily. A prospective double-blind multicentre trial on prevention of postoperative thrombosis. Br J Surg. 1986; 73: 204-208.
Bergqvist D, Matzsch T, Friselli J. Low molecular weight heparin given in the evening before surgery compared with conventional low-dose heparin in the prevention of thrombosis. Br J Surg. 1988; 75: 888-891.
Samama M, Bernard P, Bonnardot JP, Combe-Tamzali S, Lanson Y, Tissot E. Low molecular weight heparin compared with unfractionated heparin in the prevention of postoperative thrombosis. Br J Surg. 1988; 75: 128-131.
Leizorovicz A, Picolet H, Peyrieux JC, Boissel JP. Prevention of postoperative deep vein thrombosis in general surgery: a multicenter double-blind study comparing two doses of logiparin and standard heparin. Br J Surg. 1991; 78: 412-416.
Bergqvist D, Agnelli G, Cohen AT. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med. 2002; 346: 975-980.
Rasmussen MS, Jorgensen LN, Wille-Jorgensen P. Prolonged prophylaxis with dalteparin to prevent late thromboembolic complications in patients undergoing major abdominal surgery: a multicenter randomized openlabel study. J Thomb Haemost. 2006; 4: 2384-2390.
Agnelli G, Sonaglia F. Prevention of Venous Thromboembolism. Thromb Res. 2000; 97: V49-V62.
Lyman GH, Khorana AA, Falanga A, Clarke-Pearson D. American Society of Clinical Oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer. J Clin Oncol. 2007; 25: 5490-5505.
Bennet CL, Angelotta C, Yarnold PR, Evans AM, Zonder JA, Raisch DW, Richardson P. Thalidomide- and lenalidomide- associated thromboembolism among patients with cancer. JAMA. 2006; 296: 2558-2560.
NCCN Clinical Practice Guidelines in Oncology: Venous Thromboembolic Disease (V.1.2009) National Comprehensive Cancer Network Web site. guidelines.asp.
Agnes Y, Lee Y. Epidemiology and management of venous thromboembolism in patients with cancer. Thromb Res. 2003; 110: 167-172.