An expanding role for antithrombotic therapy in cancer patients.

Thromboembolic disease has a negative impact on outcome in the cancer patient. Venous thromboembolism appears to be a more aggressive disease in patients with cancer who present with both a greater thrombus burden and more pronounced derangements of coagulation parameters with non-cancer patients with thrombosis. Restrospective analyses suggest that treatment of venous thromboembolism in cancer patients with low-molecular-weight heparin is associated with additional benefits in terms of their survival. The mechanism for this effect is unclear but may be attributed to a reduced incidence of recurrent thrombosis and fatal pulmonary embolism in those patients with underlying thrombosis. To investigate and potential of low-molecular-weight heparin to prolong survival in cancer patients without underlying thrombosis, a prospective trial (FAMOUS) has evaluated the effect of treatment with the low-molecular-weight heparin dalteparin for 1 year terms of survival of patients with advanced cancer and no underlying thrombosis.