Debourdeau Philippe, Elalamy Ismail, de Raignac Axelle, Meria Paul, Gornet Jean Marc, Amah Yahovi, Korte Wolfang, Marty Michel, Farge Dominique
Internal Medicine and Oncology Department, Desgenettes Military Hospital, 108 Bvd Pinel, 69275, Lyon cedex 3, France.
Support Care Cancer. 2008 Dec;16(12):1333-41. doi: 10.1007/s00520-008-0491-4. Epub 2008 Aug 15.
Cancer disease inducing an acquired hypercoagulable state is a well-established feature. Venous thromboembolism (VTE) occurs in 4% to 20% of the patients and is the second cause of mortality in cancer; VTE incidence is four to six times higher in cancer patients compared to other patients. In the last 10 years, important randomised clinical trials have clearly demonstrated that long-term use of daily subcutaneous low molecular weight heparin (LMWH) is more efficient than Vitamin K antagonists to treat VTE in cancer patients. First Italian, then American and more recently French national guidelines recommend the use of LMWH for 3 to 6 months for curative treatment of VTE in cancer patients with a clearly high level (A) of evidence. Despite convincing data, many physicians have not yet modified their clinical practice, doubting the tolerability of such a long period of subcutaneous injections. In fact, LMWH long-term use appears well tolerated and may also increase cancer patient survival.
The aim of this review is to present the scientific rationale for long-term daily subcutaneous LMWH in cancer patients, and to reinforce the favourable benefit/tolerance tolerability ratio with this specific antithrombotic strategy.
