Thromboembolic Diseases: Mechanisms, Prophylaxis and Treatment
Proceedings 5th International Symposium on Thromboembolic Diseases
Cannes, June 12-13, 1998
Editors: V.V. Kakkar, London; M.M. Samama, Paris

Main Paper

Thromboprophylaxis in the Cancer Patient
Ajay K. Kakkar, Robin C.N. Williamson

Department of Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, UK

Address of Corresponding Author

Haemostasis 1998;28:61-65 (DOI: 10.1159/000022406)

  Key Words

• Deep vein thrombosis
• Low-molecular-weight heparin
• Thromboprophylaxis
• Chemotherapy
• Cancer

  Abstract

Thrombosis is a common complication in patients with malignant disease resulting from tumour elaboration of procoagulants and subsequent activation of intravascular coagulation. Cancer therapies (operation, chemotherapy and the use of central venous lines) further heighten the risk of thrombosis. The risk of thrombosis in cancer operations is of sufficient magnitude to necessitate routine thromboprophylaxis, for which low-dose unfractionated heparin or the low-molecular-weight heparins (LMWHs) have been proven effective and safe. Thrombotic complications with chemotherapy have been extensively described in women receiving either adjuvant or palliative cytotoxic or hormonal therapy for breast carcinoma. The problems are common, but of all the suitable prophylactic modalities available, only oral anticoagulants have been evaluated for this indication. Thrombosis complicates the use of central venous catheters in the cancer patient and both low-dose warfarin and LMWHs are effective in protecting against line-associated thrombi. Recent evidence from the retrospective analyses of randomized studies comparing unfractionated heparin and LMWH in the treatment of deep vein thrombosis have shown a striking mortality reduction among cancer patients who received LMWH. The use of LMWHs to prolong survival in patients with advanced malignant disease is currently the subject of a prospective, randomized, placebo-controlled study.

  Author Contacts

Dr. A.K. Kakkar
Department of Surgery
Imperial College School of Medicine
Hammersmith Hospital, Du Cane Road
London W12 0NN (UK)

  Article Information

Number of Print Pages : 5
Number of Figures : 0, Number of Tables : 0, Number of References : 17