Clinical Use of the Low-Molecular-Weight Heparins in Cancer Patients: Focus on the Improved Patient Outcomes

Abstract

Patients with malignant neoplastic diseases represent a high-risk population relative to thromboembolic disease. With the advent of improved and accessible diagnostic technology, for example, ultrasound and/or spiral CT scans, timely diagnosis of venous thromboembolic events (VTE) is readily accomplished. The introduction of low-molecular-weight heparin (LMWH) approximately two decades ago (in contrast to unfractionated heparin and vitamin K antagonists) has provided a class of agents with a favorable therapeutic index. In the review to follow, the literature regarding the use of LMWH in oncologic patient populations is summarized. Topics addressed include prophylaxis, and treatment as well as consideration of the potential anti-neoplastic properties of this class of drugs.

Coagulopathy, Venous Thromboembolism, and Anticoagulation in Patients with COVID‐19

“…Use of LMWH instead of UFH will reduce exposure of health care professionals to patients with COVID‐19, as well as preserving personal protective equipment. The preference for LMWH over UFH for prophylaxis is also based on benefit of LMWH over UFH in other high risk patients, such as those with trauma, cancer, and high risk medically ill patients 107–112 …”

Thromboembolism during neoadjuvant therapy for rectal cancer: a systematic review

“…Additive TE risk factors, such as obesity, prior TE and the presence of metastases, are well described. At present, TP prescribing during nT should therefore be made on a case‐by‐case basis using LMWH, which is known to be safer and more efficacious than oral vitamin K antagonists . The safety and efficacy of newer, oral, direct thrombin inhibitors, such as dabigatran, is currently unknown.…”

Fatal Paraneoplastic Embolisms in Both Circulations in a Patient with Poorly Differentiated Neuroendocrine Tumour

“…Some authors suggest UFH or LMWH in combination with the direct thrombin inhibitor fondaparinux [ 6 , 29 ]. In this context, UFH is known to affect more different sites in the coagulation cascade as LMWH [ 30 ]. The role of platelet inhibition is unclear.…”