Bayer Pharma AG

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Low-molecular-weight heparins (LMWHs) and unfractionated heparin (UFH) have been shown to have similar efficacy for thromboprophylaxis in patients with cancer. Both agents are recommended by the 2012 ACCP guidelines for thromboprophylaxis in patients with cancer who are at increased risk of venous thromboembolism (VTE). Vitamin K antagonists (VKAs) and fondaparinux are two other options for the prevention of VTE in patients with cancer. Although some clinical studies have demonstrated a benefit for thromboprophylaxis in hospitalized and surgical patients with cancer, it is not routinely recommended for ambulatory cancer patients. Despite the guideline recommendations, adequate VTE prophylaxis is currently underused in patients with cancer.

Venous thromboembolism prevention in patients with cancer

LMWHs and UFH have been shown to have similar efficacy for thromboprophylaxis in patients with cancer.288 Both agents are recommended by the 2012 ACCP guidelines for thromboprophylaxis in patients with cancer who are at increased risk of VTE.289, 290 In addition to their antithrombotic effects,291, 292 heparins may also exert antitumor effects but clinical evidence needs to be confirmed.293

Other pharmacological options for the prevention of VTE in patients with cancer VKAs and fondaparinux.278 Although some clinical studies have demonstrated a benefit for thromboprophylaxis in hospitalized and surgical patients with cancer, it is not routinely recommended for ambulatory cancer patients. Click here for a summary of the guidelines.

Several studies have investigated thromboprophylaxis in surgical patients with cancer, but data in non-surgical patients with cancer is limited and usually comes from studies of larger medically ill patient cohorts.291, 294, 295 In addition, the optimal duration of VTE prophylaxis in patients with cancer is still not clear.295-297

Adequate VTE prophylaxis is currently underused in patients with cancer.294, 298

  • In a study of patients undergoing major orthopaedic or major cancer surgery in 14 Swiss hospitals:
    • The lowest prescription rates for VTE prophylaxis were found in patients who had undergone surgery for thoracic, gastrointestinal or hepatobiliary cancer298
    • The median duration of extended prophylaxis was shown to be significantly shorter in those patients undergoing cancer surgery (23 days), compared with orthopaedic surgery (32 days)298
  • In a multinational survey that evaluated VTE risk and prophylaxis use in a cohort of 37,000 hospitalized medical patients:
    • A total of 34% of patients with active cancer were considered at risk of VTE based on the 2004 ACCP guidelines, but only 44% of these patients actually received appropriate VTE prophylaxis294

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