Skip to main content

Advertisement

SpringerLink
Log in

Prophylactic anti-coagulation in cancer palliative care: a prospective randomised study

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Goals

The objective of this study was to determine utility of prophylactic anti-coagulation in cancer patients hospitalised for palliative care in a specialised centre.

Materials and methods

Prospective 1:1 open randomised study was designed. Twenty patients aged 55 to 88 years with advanced cancer and an estimated life expectancy of less than 6 months were assigned to either receive treatment with 2,850/3,800 U (<70/>70 kg) of daily subcutaneous nadroparin or no treatment. Suspicion of venous thrombo-embolism (deep vein thrombosis and pulmonary embolism) was confirmed by echo-Doppler examination of the lower limbs and/or by spiral computed tomography scan of the lungs. Bleeding episodes were recorded. Platelet count was measured on days 7 and 14. Survival time from study entry was determined.

Main results

One venous thrombo-embolism and one major bleeding occurred in the group receiving nadroparin, whereas two minor bleedings occurred in the control group. At 3 months, nine of ten participants had died in the control group vs five of ten in the group receiving nadroparin (P = 0.141). Five participants could be discharged home (P = 0.141).

Conclusions

Decision to administer prophylactic nadroparin in hospitalised cancer patients under palliative care remains a challenge. Better mobility score at admission and the likelihood to be discharged home may be useful for practical purposes. The observation of a potential influence of prophylactic nadroparin on survival deserves further studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Agrawal M, Danis M (2002) End-of-life care for terminally ill participants in clinical research. J Palliat Med 5:729–737

    Article  PubMed  Google Scholar 

  2. Baron JA, Gridley G, Weiderpass E, Nyren O, Linet M (1998) Venous thromboembolism and cancer. Lancet 351:1077–1080

    Article  PubMed  CAS  Google Scholar 

  3. Bruera E, Neumann CM (1998) Management of specific symptom complexes in patients receiving palliative care. Can Med Assoc J 158:1717–1726

    CAS  Google Scholar 

  4. Bruera E, Miller L, McCallion J, Macmillan J et al (1992) Cognitive failure in patients with terminal cancer: a prospective study. J Pain Symptom Manage 7:192–195

    Article  PubMed  CAS  Google Scholar 

  5. Casarett DJ, Karlawish JHT (2000) Are special ethical guidelines needed for palliative care research? J Pain Symptom Manage 20:130–139

    Article  PubMed  CAS  Google Scholar 

  6. Deitcher SR, Gomes MP (2004) The risk of venous thromboembolic disease associated with adjuvant hormone therapy for breast carcinoma: a systematic review. Cancer 101:439–449

    Article  PubMed  Google Scholar 

  7. Federal Office of Statistics (Switzerland). http://www.bfs.admin.ch/

  8. Folstein MF, Folstein SE, Mc Hugh PR (1975) Mini-Mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  PubMed  CAS  Google Scholar 

  9. Goodnough LT, Saito H, Manni A, Jones PK, Pearson OH (1984) Increased incidence of thromboembolism in stage IV breast cancer patients treated with a five-drug chemotherapy regimen. A study of 159 patients. Cancer 54:1264–1268

    Article  PubMed  CAS  Google Scholar 

  10. Gouin-Thibaut I, Samama MM (2000) Venous thrombosis and cancer. Ann Biol Clin (Paris) 58:675–682

    CAS  Google Scholar 

  11. Hawryluck L (2004) People at the end of life are a vulnerable research population. Clin Oncol 16:225–226

    Article  CAS  Google Scholar 

  12. Jacobs LG (2003) Prophylactic anticoagulation for venous thromboembolic disease in geriatric patients. J Am Geriatr Soc 51:1472–1478

    Article  PubMed  Google Scholar 

  13. Jilma B, Kamath S, Lip GYH (2003) Antithrombotic therapy in special circumstances. II-in children, thrombophilia, and miscellanaous conditions. Br Med J 326:93–96

    Article  Google Scholar 

  14. Johnson MJ, Sherry K (1997) How do palliative physicians manage venous thromboembolism? Palliat Med 11:462–468

    Article  PubMed  CAS  Google Scholar 

  15. Kakkar AK, Levine MN, Kadziola Z et al (2004) Low molecular weight heparin, therapy with dalteparin, and survival in advanced cancer: The Fragmin Advanced malignancy Outcome Study (FAMOUS). J Clin Oncol 22:1944–1948

    Article  PubMed  CAS  Google Scholar 

  16. Keith RA, Granger CV, Hamilton BB, Sherwin FS (1987) The functional independence measure: a new tool for rehabilitation. Adv Clin Rehabil 1:6–18

    PubMed  CAS  Google Scholar 

  17. Klerk CPW, Smorenburg SM, Otten HM et al (2005) The effect of low molecular weight heparin on survival in patients with advanced malignancy. J Clin Oncol 23:2130–2135

    Article  PubMed  CAS  Google Scholar 

  18. Koedoot CG, de Haan RJ, Stiggelbout AM et al (2003) Palliative chemotherapy or best supportive care? A prospective study explaining patients’ preference and choice. Br J Cancer 89:2219–2226

    Article  PubMed  CAS  Google Scholar 

  19. Lee AYY (2003) Epidemiology and management of venous thromboembolism in patients with cancer. Thromb Res 110:167–172

    Article  PubMed  CAS  Google Scholar 

  20. Leizorovicz A, Cohen AT, Turpie AGG et al (2004) Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation 110:874–879

    Article  PubMed  CAS  Google Scholar 

  21. Mazzocato C, Sweeney C, Bruera E (2001) Clinical research in palliative care: choice of trial design. Palliat Med 15:261–264

    Article  PubMed  CAS  Google Scholar 

  22. Merminod T, Zulian GB (2007) Venous thromboembolism in cancer patients under palliative care: retrospective study with lessons to the future. Supportive Palliative Cancer Care J (in press)

  23. Pautex S, Moynier K, Weber C, Zulian GB (2002) L’évaluation des symptômes en oncologie palliative. Méd Hyg 60:1313–1317

    Google Scholar 

  24. Samama MM, Cohen AT, Darmon JY et al (1999) A comparaison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. New Eng J Med 341:793–800

    Article  PubMed  CAS  Google Scholar 

  25. Saphner T, Tormey DC, Gray R (1991) Venous and arterial thrombosis in patients who received adjuvant therapy for breast cancer. J Clin Oncol 9:286–294

    PubMed  CAS  Google Scholar 

  26. Trousseau A (1865) Phlegmasia Alba Dolens. Clinique médicale de l’Hôtel Dieu de Paris, vol 3. The New Sydenham Society, London, p 94

    Google Scholar 

  27. Wilson CB, Lambert HE, Scott RD (1987) Subclavian and axillary vein thrombosis following radiotherapy for carcinoma of the breast. Clin Radiol 38:95–96

    Article  PubMed  CAS  Google Scholar 

  28. World Heath Organization. http://www.who.int/cancer/palliative/definition/en/

  29. Yancik R (2005) Population aging and cancer: a cross-national concern. Cancer 11:437–441

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Rehabilitation and Geriatrics, Service of Palliative Medicine Cesco, University Hospitals of Geneva, 11 chemin de la Savonnière, 1245, Collonge-Bellerive, Switzerland

    Catherine Weber, Thierry Merminod, François R. Herrmann & Gilbert B. Zulian

Authors
  1. Catherine Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thierry Merminod
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. François R. Herrmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gilbert B. Zulian
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gilbert B. Zulian.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Weber, C., Merminod, T., Herrmann, F.R. et al. Prophylactic anti-coagulation in cancer palliative care: a prospective randomised study. Support Care Cancer 16, 847–852 (2008). https://doi.org/10.1007/s00520-007-0339-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-007-0339-3

Keywords

Search

Navigation