Long-term treatment with dalteparin low-molecular-weight heparin (LMWH) may improve survival in patients with non-metastatic malignancy and venous thromboembolism (VTE)

Lee, A. Y. Y.; Julian, JoAnne; Levine, Mark; Baker, R; Bowden, C.L.; Kakkar, Ajay K.; Prins, MH; Rickles, Frederick R.; Gent, Michael

doi:10.1111/j.1538-7836.2003.tb03300.x

Cited by 6 publications

(4 citation statements)

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“…26 Long-term treatment with LMWH is as effective and safe as with VKAs 27 but is not preferred by most patients as daily injections are needed. In patients with cancer, treatment with LMWH offers several practical advantages (including that there are no interactions, coagulation monitoring is not required, and bridging therapy is not needed in the event of invasive procedures) and appears to have a survival benefit in a subset of these patients, 28 and so is recommended for the first 3 to 6 months of secondary prophylaxis. 26 There is a tendency to continue prophylaxis for longer after a first episode of unprovoked VTE as the risk of recurrence is still present many years after the initial event.…”

Section: Case 2: Treatment Of Deep Vein Thrombosismentioning

confidence: 99%

Ximelagatran in the Clinic: Practical Management of Patients

Schulman

Lip²

2005

Seminars in Vascular Medicine

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Section: Case 2: Treatment Of Deep Vein Thrombosismentioning

confidence: 99%

Ximelagatran in the Clinic: Practical Management of Patients

Schulman

Lip²

2005

Seminars in Vascular Medicine

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“…Recent randomized trials of low-molecularweight heparins in cancer patients suggest that there may still be a potential role for anticoagulation in improving the survival of cancer patients. [23][24][25][26] In addition, newly developed oral factor Xa and thrombin inhibitors may provide a safer and more convenient approach to the use of anticoagulation in cancer patients.…”

Section: Resultsmentioning

confidence: 99%

The Role of Oral Anticoagulants in Tumor Biology

Weitz¹,

Liebman²

2007

Semin Thromb Hemost

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Pathology studies of human cancers suggested to early investigators that the hemostatic system may play an important role in cancer metastasis. Subsequent studies in animal models have demonstrated a reduction of tumor metastasis and improved animal survival with systemic anticoagulation. In many of these experiments, vitamin K antagonists (VKAs) were utilized. Although warfarin was effective in reducing metastasis in a majority of these animal models, effects on the growth of the primary tumor and on animal survival have been less consistent. Clinical studies on the effect of warfarin in human malignancy are limited and less than conclusive. Several small, uncontrolled and controlled clinical studies have been reported but do not definitively suggest a benefit in most malignancies. However, none of the studies of VKAs in humans are adequately designed or sufficiently powered to definitively exclude an impact of oral anticoagulants on cancer survival. Because of the difficulties in managing VKA oral anticoagulation in cancer patients and recent studies suggesting a positive effect on cancer survival with low-molecular-weight heparins, it unlikely that further studies on the use of VKAs in cancer patients will be undertaken.

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“…No difference was observed between treatment groups in the patients with metastatic cancer. In the subgroup of 150 patients with non‐metastatic solid tumors at randomization, over the 12‐month follow‐up period, the cumulative mortality in the dalteparin and warfarin groups was 20% and 35%, respectively ( P = 0.03) [53]. These findings suggest that long‐term dalteparin treatment rather than oral VKA treatment may extend survival in cancer patients with non‐metastatic disease and acute VTE.…”

Section: The Effects Of Heparins and Vka On Survival In Patients Withmentioning

confidence: 99%

Primary and secondary prophylaxis of venous thromboembolism with low-molecular-weight heparins: prolonged thromboprophylaxis, an alternative to vitamin K antagonists

Kher¹,

Samama

2005

Journal of Thrombosis and Haemostasis

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To cite this article: Kher A, Samama MM. Primary and secondary prophylaxis of venous thromboembolism with low-molecular-weight heparin:prolonged thromboprophylaxis, an alternative to vitamin K antagonists. J Thromb Haemost 2005; 3: 473-81.Summary. Low-molecular-weight heparins (LMWHs) are used widely in the treatment and prevention of venous thromboembolism (VTE). The LMWHs dalteparin and enoxaparin reduce the rate of VTE by at least 50% if administered for 4-5 weeks following major orthopedic surgery, compared with in-hospital prophylaxis for 7-15 days. Meta-analyses have confirmed that the size of the reduction is similar for both clinical and asymptomatic VTE. Vitamin K antagonists (VKAs) have been shown to be associated with significantly higher bleeding rates compared with LMWH when used as prolonged prophylaxis against VTE following major orthopedic surgery. Patients with cancer are a recognized group at high risk of VTE, and those undergoing major surgery for their malignancy are at particular risk. Evidence from clinical trials is amassing to show that prolonged prophylaxis with LMWH (dalteparin, enoxaparin) in these patients can significantly reduce the rate of postoperative VTE. In cancer patients with acute VTE, the traditional approach is to initiate acute treatment with unfractionated heparin or LMWH followed by long-term treatment with VKA to prevent recurrence. However, clinical trial data have confirmed that the LMWH dalteparin, when administered for 6 months, is significantly more effective than VKA in preventing recurrence, cutting the rate of VTE by 52% without increasing the risk of bleeding. A new and intriguing area of interest is whether LMWH can enhance survival in patients with cancer. Preliminary data suggest that a biological effect of LMWH may act to prolong survival in patients with cancer.

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Long-term treatment with dalteparin low-molecular-weight heparin (LMWH) may improve survival in patients with non-metastatic malignancy and venous thromboembolism (VTE)

Cited by 6 publications

References 0 publications

Ximelagatran in the Clinic: Practical Management of Patients

Ximelagatran in the Clinic: Practical Management of Patients

The Role of Oral Anticoagulants in Tumor Biology

Primary and secondary prophylaxis of venous thromboembolism with low-molecular-weight heparins: prolonged thromboprophylaxis, an alternative to vitamin K antagonists

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