Venous thromboembolism is a common complication in patients with cancer. Th
e management of deep vein thrombosis and pulmonary embolism can be a consid
erable challenge in patients with cancer. The cancer itself and associated
treatments contribute to an ongoing thrombogenic stimulus, while cancer pat
ients are thought to be at increased risk for anticoagulant-induced bleedin
g. Initial treatment of acute thromboembolism is with intravenous unfractio
nated heparin or subcutaneous low molecular weight heparin. Treatment at ho
me with low molecular weight heparin is an attractive option in patients wi
th malignant disease. Long-term treatment of acute venous thromboembolism h
as traditionally been with oral anticoagulants. However, the inconvenience
and narrow therapeutic window of oral anticoagulants make such therapy unat
tractive and problematic in cancer patients. Low molecular weight heparins
are being evaluated as an alternative for long-term therapy because their a
nticoagulant effects are more predictable and laboratory monitoring is unne
cessary. Although many clinical issues remain unresolved in the treatment o
f cancer patients with venous thromboembolism, the future holds much promis
e as new antithrombotic agents, including factor Xa antagonists and oral th
rombin inhibitors, are being tested in clinical trials. Copyright (C) 2001
S. Karger AG, Basel.