Treatment of venous thromboembolism in cancer patients

The management of deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients with cancer can be a clinical dilemma. Comorbid conditions, warfa rin failure, difficult venous access, and a high bleeding risk are some of the factors that often complicate anticoagulant therapy in these patients. In addition, the use of central venous access devices is increasing but the optimal treatment of catheter-related thrombosis remains controversial. Un fractionated heparin (UFH) is the traditional standard for the initial trea tment of venous thromboembolism (VTE) but low molecular weight heparins (LM WHs) have been shown to be equally safe and effective in hemodynamically st able patients. For long-term treatment or secondary prophylaxis, vitamin K antagonists remain the mainstay treatment. However, the inconvenience and n arrow therapeutic window of oral anticoagulants make extended therapy unatt ractive and problematic. As a result, LMWHs are being evaluated as an alter native for long-term therapy. New antithrombotic agents are being tested in clinical trials and may have the potential to replace conventional treatme nt. The role of inferior vena cava filters in cancer patients remains ill d efined but these devices remain the treatment of choice in patients with co ntraindications for anticoagulant therapy. (C) 2001 Elsevier Science Ltd. A ll rights reserved.