Should patients with venous thromboembolism and cancer be treated differently?

Patients with malignant disease constitute a significant subgroup among pat ients with venous thromboembolism. Current results suggest that cancer pati ents are not only at an increased risk for thromboembolic events, particula rly during chemotherapy treatment or after surgery, they also have an incre ased risk for bleeding complications while receiving oral anticoagulant tre atment. The exact incidences of venous thromboembolic complications for the various types of cancer, however, are not well determined. Recent studies have indicated that subcutaneous low-molecular-weight heparin (LMWH) is as safe and effective as intravenous unfractionated heparin (UFH) in the initi al treatment of venous thromboembolism. Moreover, a meta-analysis has provi ded preliminary evidence that, compared with UFH, LMWH treatment may prolon g survival in cancer patients. Initiation of LMWH treatment in these patien ts is, therefore, recommended. Prospective randomized clinical trials to as sess the optimum dose and duration of therapy are called for. Copyright (C) 1999 S. Karger AG, Basel.