Treatment of Venous Thrombosis in the Cancer Patient

Abstract

Venous thromboembolism is a common complication in patients with cancer. The management of deep vein thrombosis and pulmonary embolism can be a considerable challenge in patients with cancer. The cancer itself and associated treatments contribute to an ongoing thrombogenic stimulus, while cancer patients are thought to be at increased risk for anticoagulant-induced bleeding. Initial treatment of acute thromboembolism is with intravenous unfractionated heparin or subcutaneous low molecular weight heparin. Treatment at home with low molecular weight heparin is an attractive option in patients with malignant disease. Long-term treatment of acute venous thromboembolism has traditionally been with oral anticoagulants. However, the inconvenience and narrow therapeutic window of oral anticoagulants make such therapy unattractive and problematic in cancer patients. Low molecular weight heparins are being evaluated as an alternative for long-term therapy because their anticoagulant effects are more predictable and laboratory monitoring is unnecessary. Although many clinical issues remain unresolved in the treatment of cancer patients with venous thromboembolism, the future holds much promise as new antithrombotic agents, including factor Xa antagonists and oral thrombin inhibitors, are being tested in clinical trials.

Coagulation and cancer: Implications for diagnosis and management

“…69,84 The risk of clinically important hemorrhage with therapeutic heparin is approximately 5%, thus, it is very important, during heparin treatment, to monitor various tests of blood coagulation, particularly the activated partial thromboplastin time (aPTT), which, if prolonged, suggests an increased risk of bleeding. 59,116 The risk in patients with malignancy has been discussed in recent studies, with conflicting results. In a multivariate analysis, tumors were associated with major hemorrhages with a relative hazard ratio of 4.07; 116 on the contrary, Prandoni et al did not find differences in patients with cancer compared to those without cancer.…”

Expression of coagulation factors and their receptors in tumor tissue and coagulation factor upregulation in peripheral blood of patients with cerebral carcinoma metastases

“…Patients with a malignant tumor disease have a higher risk to develop deep vein thrombosis or pulmonary embolism (Levine and Lee 2001;Sawaya and Ligon 1994). Therefore, thrombembolic complications are the second most death reason among hospitalized tumor patients (Pruemer 2005;Thodiyil et al 2001).…”

Blood Loss and Massive Transfusion in Patients Undergoing Major Oncological Surgery: What Do We Know?

“…However, patients with cancer may also have other factors that contribute to significant perioperative bleeding. It is well known that hematological and nonhematological malignancies activate the blood coagulation system through the release of procoagulant factors, activation of the antifibrinolytic pathways, and the creation of an imbalance between pro-and antiinflammatory cytokines, which favor the production of peripheral clots in the majority of patients [16,17]. This procoagulant state may also continue into the postoperative period [18].…”

“…Patients with cancer are at risk for significant bleeding due to tumor-related factors such as proximity or invasion of major vascular structures or hypervascularization of the cancerous tissue itself [17,18]. Lastly, it is also well known that major tissue trauma as observed in extensive oncological surgery may alter the functional equilibrium between soluble plasma fractions, erythrocytes, leukocytes, platelets, and the fibrinolytic system.…”