Treatment of venous thrombosis in the cancer patient

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.