Parenteral anticoagulation in ambulatory patients with cancer

Abstract

Heparin may have a small effect on mortality at 12 months and 24 months. It is associated with a reduction in venous thromboembolism and a likely increase in minor bleeding. Future research should further investigate the survival benefit of different types of anticoagulants in patients with different types and stages of cancer. The decision for a patient with cancer to start heparin therapy for survival benefit should balance the benefits and downsides, and should integrate the patient's values and preferences.

Systemic Anticoagulation and Inpatient Outcomes of Pancreatic Cancer: Real-World Evidence from U.S. Nationwide Inpatient Sample

“…The combinatorial treatment with anticoagulant use provided extra tumor reduction by 24.3% compared to treatment with the drug only [ 34 ]. Other recent studies also suggest that anticoagulants improve survival in cancer patients through antitumor effects in addition to antithrombotic effects [ 35 , 36 , 37 ]. Although those studies do not specifically focus on pancreatic cancer, their conclusions are relevant to our finding that long-term systemic anticoagulation use was associated with better inpatient outcomes.…”

Systemic Anticoagulation and Inpatient Outcomes of Pancreatic Cancer: Real-World Evidence from U.S. Nationwide Inpatient Sample

“…The combinatorial treatment with anticoagulant use provided extra tumor reduction by 24.3% compared to treatment with the drug only [ 34 ]. Other recent studies also suggest that anticoagulants improve survival in cancer patients through antitumor effects in addition to antithrombotic effects [ 35 , 36 , 37 ]. Although those studies do not specifically focus on pancreatic cancer, their conclusions are relevant to our finding that long-term systemic anticoagulation use was associated with better inpatient outcomes.…”

A randomized clinical trial on the antitumoral effects of low molecular weight heparin in the treatment of esophageal cancer

“…Despite these controversies about the survival advantages of LMWH in solid tumors, in two recent review studies by Akl et al (2014) and Zhang et al (2016), the authors concluded that LMWHs have clinical benefits in survival improvement of patients with cancer. Considering the low risk of hemorrhagic events associated with a combination of LMWHs and other chemotherapeutic agents, future investigation in evaluating different LMWH efficacies on different pathologies is warranted.…”

Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update

“…Literature review update and analysis. The updated literature review included one RCT 37 and three metaanalyses 10,22,35 that focused on anticoagulation in relation to survival in patients with cancer who did not have an indication for anticoagulation. The RASTEN trial (Clinical-Trials.gov identifier: NCT00717938) 37 evaluated the addition of enoxaparin to standard treatment in 390 patients with small-cell lung cancer.…”

“…In the 2017 Cochrane review of oral anticoagulants by Kahale et al, 22 neither VKAs nor DOACs were significantly associated with mortality, although the DOAC result was based on only a single small trial. Parenteral anticoagulants were assessed in a separate 2017 Cochrane review by Akl et al, 10 which reported no significant association between heparin (either UFH or LMWH) and mortality at 12 or 24 months. Yu et al 35 focused specifically on lung cancer and reported reduced mortality with heparin (HR, 0.71; 95% CI, 0.60 to 0.84).…”

Systemic Anticoagulation and Inpatient Outcomes of Pancreatic Cancer: Real-World Evidence from U.S. Nationwide Inpatient Sample

“…The combinatorial treatment with anticoagulant use provided extra tumor reduction by 24.3% compared to treatment with the drug only [ 34 ]. Other recent studies also suggest that anticoagulants improve survival in cancer patients through antitumor effects in addition to antithrombotic effects [ 35 , 36 , 37 ]. Although those studies do not specifically focus on pancreatic cancer, their conclusions are relevant to our finding that long-term systemic anticoagulation use was associated with better inpatient outcomes.…”

A randomized clinical trial on the antitumoral effects of low molecular weight heparin in the treatment of esophageal cancer

“…Despite these controversies about the survival advantages of LMWH in solid tumors, in two recent review studies by Akl et al (2014) and Zhang et al (2016), the authors concluded that LMWHs have clinical benefits in survival improvement of patients with cancer. Considering the low risk of hemorrhagic events associated with a combination of LMWHs and other chemotherapeutic agents, future investigation in evaluating different LMWH efficacies on different pathologies is warranted.…”

Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update

“…Literature review update and analysis. The updated literature review included one RCT 37 and three metaanalyses 10,22,35 that focused on anticoagulation in relation to survival in patients with cancer who did not have an indication for anticoagulation. The RASTEN trial (Clinical-Trials.gov identifier: NCT00717938) 37 evaluated the addition of enoxaparin to standard treatment in 390 patients with small-cell lung cancer.…”

“…In the 2017 Cochrane review of oral anticoagulants by Kahale et al, 22 neither VKAs nor DOACs were significantly associated with mortality, although the DOAC result was based on only a single small trial. Parenteral anticoagulants were assessed in a separate 2017 Cochrane review by Akl et al, 10 which reported no significant association between heparin (either UFH or LMWH) and mortality at 12 or 24 months. Yu et al 35 focused specifically on lung cancer and reported reduced mortality with heparin (HR, 0.71; 95% CI, 0.60 to 0.84).…”

Systemic Anticoagulation and Inpatient Outcomes of Pancreatic Cancer: Real-World Evidence from U.S. Nationwide Inpatient Sample

“…The combinatorial treatment with anticoagulant use provided extra tumor reduction by 24.3% compared to treatment with the drug only [ 34 ]. Other recent studies also suggest that anticoagulants improve survival in cancer patients through antitumor effects in addition to antithrombotic effects [ 35 , 36 , 37 ]. Although those studies do not specifically focus on pancreatic cancer, their conclusions are relevant to our finding that long-term systemic anticoagulation use was associated with better inpatient outcomes.…”

A randomized clinical trial on the antitumoral effects of low molecular weight heparin in the treatment of esophageal cancer

“…Despite these controversies about the survival advantages of LMWH in solid tumors, in two recent review studies by Akl et al (2014) and Zhang et al (2016), the authors concluded that LMWHs have clinical benefits in survival improvement of patients with cancer. Considering the low risk of hemorrhagic events associated with a combination of LMWHs and other chemotherapeutic agents, future investigation in evaluating different LMWH efficacies on different pathologies is warranted.…”

Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update

“…Literature review update and analysis. The updated literature review included one RCT 37 and three metaanalyses 10,22,35 that focused on anticoagulation in relation to survival in patients with cancer who did not have an indication for anticoagulation. The RASTEN trial (Clinical-Trials.gov identifier: NCT00717938) 37 evaluated the addition of enoxaparin to standard treatment in 390 patients with small-cell lung cancer.…”

“…In the 2017 Cochrane review of oral anticoagulants by Kahale et al, 22 neither VKAs nor DOACs were significantly associated with mortality, although the DOAC result was based on only a single small trial. Parenteral anticoagulants were assessed in a separate 2017 Cochrane review by Akl et al, 10 which reported no significant association between heparin (either UFH or LMWH) and mortality at 12 or 24 months. Yu et al 35 focused specifically on lung cancer and reported reduced mortality with heparin (HR, 0.71; 95% CI, 0.60 to 0.84).…”