Thromboprophylaxis in the cancer patient

Thrombosis is a common complication in patients with malignant disease resu lting from tumour elaboration of procoagulants and subsequent activation of intravascular coagulation. Cancer therapies (operation, chemotherapy and t he use of central venous lines) further heighten the risk of thrombosis. Th e risk of thrombosis in cancer operations is of sufficient magnitude to nec essitate routine thromboprophylaxis, for which low-dose unfractionated hepa rin or the low-molecular-weight heparins (LMWHs) have been proven effective and safe, Thrombotic complications with chemotherapy have been extensively described in women receiving either adjuvant or palliative cytotoxic or ho rmonal therapy for breast carcinoma. The problems are common, but of all th e suitable prophylactic modalities available, only oral anticoagulants have been evaluated for this indication, Thrombosis complicates the use of cent ral venous catheters in the cancer patient and both low-dose warfarin and L MWHs are effective in protecting against line-associated thrombi, Recent ev idence from the retrospective analyses of randomized studies comparing unfr actionated heparin and LMWH in the treatment of deep vein thrombosis have s hown a striking mortality reduction among cancer patients who received LMWH . The use of LMWHs to prolong survival in patients with advanced malignant disease is currently the subject of a prospective, randomized, placebo-cont rolled study.