Long-term use of daily subcutaneous low molecular weight heparin in cancer patients with venous thromboembolism: why hesitate any longer?

Abstract

The aim of this review is to present the scientific rationale for long-term daily subcutaneous LMWH in cancer patients, and to reinforce the favourable benefit/tolerance tolerability ratio with this specific antithrombotic strategy.

Low molecular weight heparins for current and future uses: approaches for micro- and nano-particulate delivery

“…Therefore, LMWHs have received widespread acceptance as the anticoagulant of choice not only for short-term treatment of deep venous thrombosis (DVT) and pulmonary embolism (PE) (Bai & Ahsan, 2010) but also for prolonged duration thromboprophylaxis in certain pathologic conditions, such as cancer (Schulman, 2003;Kher & Samama, 2005;Debourdeau et al, 2008;Walter et al, 2014). Moreover, LMWHs have been used for maintenance of vessel patency during hemodialysis and artery bypass grafting (Patel et al, 2009), prevention of acute bronchoconstrictor responses and airway hyper-responsiveness in asthma (Campo et al, 1999;Ahmed et al, 2000) and regulation of growth factor activity in various vascular disorders and angiogenesis (Reyes-Ortega et al, 2013).…”

Implementing Thrombosis Guidelines in Cancer Patients: A Review

“…Clinicians may avoid the long-term use of LMWH in patients with cancer due to presumed intolerance and low patient acceptance of subcutaneous injections 56. Many oncologists do not prescribe LMWH for 3 or 6 months to avoid additional treatment burden for patients,20 but such concerns may not be valid (Table 3).…”

“…Many oncologists do not prescribe LMWH for 3 or 6 months to avoid additional treatment burden for patients,20 but such concerns may not be valid (Table 3). 56 It has been demonstrated that, similar to patients with diabetes, cancer patients can cope with the injections as long as they understand their benefits 57…”

“…HIT, heparin-induced thrombocytopenia; LMWH, low-molecular weight heparin; VKA, vitamin K agonist. Reprinted with permission from Debourdeau et al56…”

“…Thrombocytopenia is generally associated with simultaneous use of chemotherapy and bone marrow infiltration, rather than with the use of heparin 56. In fact, thrombocytopenia related to heparin use in patients with cancer is more frequent with UFH than LMWH56 and, in most cases, is related to cancer treatment.…”