Prevention of venous thromboembolism in cancer patients

Thrombosis is a common complication in patients with malignancy and its occ urrence is heightened by therapeutic interventions such as operations or th e use of chemotherapy, The magnitude of the risk for venous thromboembolism (VTE) is well established for cancer surgery where rates twice that for ab dominal surgery in noncancer subjects are described. The case for routine t hromboprophylaxis in patients receiving chemotherapy is less clear, and pro spective studies investigating rates of thrombosis by tumor type, stage of disease, and chemotherapeutic regimens are required. For thromboprophylaxis in the surgical patient either low-dose heparin or low-molecular-weight (L MW) heparin are effective and safe. For patients receiving chemotherapy in advanced breast cancer, low-dose warfarin is effective. Interestingly, hepa rin therapy may prolong survival in patients with malignant disease; the me chanism is unclear, and observations from retrospective analysis need to be confirmed in prospective studies.