Comparative assessment of low-molecular-weight heparins in cancer from the perspective of patient outcomes and survival

Abstract

Patients with cancer are at high risk of developing venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism. Compared to non-cancer patients, VTE in cancer is more frequently associated with clinical consequences, including recurrent VTE, bleeding, and an increase in the risk of death. Low-molecular-weight heparins (LMWHs) are commonly recommended for the prevention and treatment of VTE in cancer patients because of their favorable risk-to-benefit profile. Indeed, compared with vitamin K antagonists, LMWHs are characterized by a reduced need for coagulation monitoring, few major bleeding episodes, and once-daily dosing, which make these drugs more suitable in the cancer setting. Guidelines have been published recently with the aim to improve the clinical outcomes in cancer patients at risk of VTE and its complications. Coagulation activation in cancer may have a role not only in thrombosis but also in tumor growth and dissemination. Hence, inhibition of fibrin formation has been considered a possible tool against the progression of malignant disease. Clinical studies show that anticoagulant drugs may have a beneficial effect on survival in cancer patients, with a major role for LMWHs. Recently a number of prospective randomized clinical trials to test LMWHs to improve cancer survival as a primary endpoint in cancer patients have been conducted. Although the results are controversial, the interest in this research area remains high.

Influence of Fucoidans on Hemostatic System

“…Commercially available, low-molecular-weight heparin Clexane ® (enoxaparin) was chosen as a reference, as this polysaccharide is intensively used in medical practice as a heparinoid anticoagulant with low risk of side effects [2,25,26]. The profiles of anticoagulant activity of the samples and Clexane ® were compared.…”

“…The situation leads to increased utilization of anticoagulant and antithrombotic agents in medical practice. Heparin and its derivatives are usually recommended as support therapy [1,2], but side effects of these medicines, like hemorrhage and heparin-induced thrombocytopenia, force the search for anticoagulants of another nature.…”

Characterization of the thrombin generation potential of leukemic and solid tumor cells by calibrated automated thrombography

“…This may provide the basis for evaluating new specifically targeted therapies for cancer and the prevention of thrombosis. 31 Randomized clinical trials have suggested a beneficial effect of heparins on cancer survival. However, for cancers expressing high levels of TF, the inhibition of FXa or FIIa alone might be not enough to control the procoagulant phenotype of tumor cells.…”

The Role of Pulmonary Veins in Cancer Progression from a Computed Tomography Viewpoint

“…Chemokines are also related to tumor progression and metastasis [ 38 ]. Maintenance of LMWH therapy is suggested for secondary prevention [ 39 , 40 ] and probably confers a survival benefit [ 41 , 41 , 42 ]. Underlying disease therapy can be conducted if it is considered useful in overcoming drug resistance; however, it is overall advantageous to avoid rigorous treatment in order to prevent cytokine overproduction [ 43 ].…”