Skip to main content

Treatment of Venous Thrombosis

  • Chapter
  • First Online:
Coagulation in Cancer

Part of the book series: Cancer Treatment and Research ((CTAR,volume 148))

  • 1263 Accesses

Approximately 20% of all cases of venous thromboembolism (VTE) are related to underlying malignancy. Many of these patients are elderly, receiving anti-cancer therapy, and have advanced malignancy and other comorbid diseases. Consequently, managing VTE in these patients is a challenging task because they have high risks of recurrent thrombosis and anticoagulant-related bleeding. Quality of life is also an important consideration when planning therapy, especially if the patient’s life expectancy is short. Of the currently available anticoagulants, monotherapy with a low-molecular-weight heparin (LMWH) is the recommended treatment of choice over unfractionated heparin and warfarin. Preliminary evidence has also suggested that LMWHs may improve survival in cancer patients. However, many aspects of treatment, such as duration of therapy, remain unstudied.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. van Dongen CJ, van den Belt AG, Prins MH, Lensing AW. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst Rev 2004;(4):CD001100.

    Google Scholar 

  2. Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133(6 Suppl):454S-545S.

    Article  PubMed  CAS  Google Scholar 

  3. Kearon C, Ginsberg JS, Julian JA, Douketis J, Solymoss S, Ockelford P et al. Comparison of fixed-dose weight-adjusted unfractionated heparin and low-molecular-weight heparin for acute treatment of venous thromboembolism. JAMA 2006;296(8):935–942.

    Article  PubMed  CAS  Google Scholar 

  4. Buller HR, Davidson BL, Decousus H, Gallus A, Gent M, Piovella F et al. Subcutaneous fondaparinux versus intravenous unfractionated heparin in the initial treatment of pulmonary embolism. N Engl J Med 2003;349(18):1695–1702.

    Article  PubMed  CAS  Google Scholar 

  5. Buller HR, Davidson BL, Decousus H, Gallus A, Gent M, Piovella F et al. Fondaparinux or enoxaparin for the initial treatment of symptomatic deep venous thrombosis: a randomized trial. Ann Intern Med 2004;140(11):867–873.

    PubMed  Google Scholar 

  6. Levine M, Gent M, Hirsh J, LeClerc J, Anderson D, Weitz J et al. A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis [see comments]. N Engl J Med 1996;334(11):677–681.

    Article  PubMed  CAS  Google Scholar 

  7. Koopman MM, Prandoni P, Piovella F, Ockelford PA, Brandjes DP, van der MJ et al. Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low- molecular-weight heparin administered at home. The Tasman Study Group [see comments] [published erratum appears in N Engl J Med 1997 Oct 23;337(17):1251]. N Engl J Med 1996;334(11):682–687.

    Article  PubMed  CAS  Google Scholar 

  8. Columbus Investigators. Low-molecular-weight heparin in the treatment of patients with venous thromboembolism. The Columbus Investigators. N Engl J Med 1997;337(10):657–662.

    Article  Google Scholar 

  9. Merli G, Spiro TE, Olsson CG, Abildgaard U, Davidson BL, Eldor A et al. Subcutaneous enoxaparin once or twice daily compared with intravenous unfractionated heparin for treatment of venous thromboembolic disease. Ann Intern Med 2001;134(3):191–202.

    PubMed  CAS  Google Scholar 

  10. Wells PS, Kovacs MJ, Bormanis J, Forgie MA, Goudie D, Morrow B et al. Expanding eligibility for outpatient treatment of deep venous thrombosis and pulmonary embolism with low-molecular-weight heparin: a comparison of patient self-injection with homecare injection [see comments]. Arch Intern Med 1998;158(16):1809–1812.

    Article  PubMed  CAS  Google Scholar 

  11. Harrison L, McGinnis J, Crowther M, Ginsberg J, Hirsh J. Assessment of outpatient treatment of deep-vein thrombosis with low- molecular-weight heparin [see comments]. Arch Intern Med 1998;158(18):2001–2003.

    Article  PubMed  CAS  Google Scholar 

  12. O'Shaughnessy D, Miles J, Wimperis J. UK patients with deep-vein thrombosis can be safely treated as out-patients. QJM 2000;93(10):663–667.

    Article  PubMed  Google Scholar 

  13. Ageno W, Steidl L, Marchesi C, Dentali F, Mera V, Squizzato A et al. Selecting patients for home treatment of deep vein thrombosis: the problem of cancer. Haematologica 2002;87(3):286–291.

    PubMed  Google Scholar 

  14. Avritscher EB, Cantor SB, Shih YC, Escalante CP, Rivera E, Elting LS. Cost-minimization analysis of low-molecular-weight heparin (dalteparin) compared to unfractionated heparin for inpatient treatment of cancer patients with deep venous thrombosis. Support Care Cancer 2004;12(7):531–536.

    Article  PubMed  Google Scholar 

  15. Breddin HK, Hach-Wunderle V, Nakov R, Kakkar VV. Effects of a low-molecular-weight heparin on thrombus regression and recurrent thromboembolism in patients with deep-vein thrombosis. N Engl J Med 2001;344(9):626–631.

    Article  PubMed  CAS  Google Scholar 

  16. Prandoni P, Lensing AW, Piccioli A, Bernardi E, Simioni P, Girolami B et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 2002;100(10):3484–3488.

    Article  PubMed  CAS  Google Scholar 

  17. Hutten BA, Prins MH, Gent M, Ginsberg J, Tijssen JG, Buller HR. Incidence of recurrent thromboembolic and bleeding complications among patients with venous thromboembolism in relation to both malignancy and achieved international normalized ratio: a retrospective analysis. J Clin Oncol 2000;18(17):3078–3083.

    PubMed  CAS  Google Scholar 

  18. Gates S, Brocklehurst P, Davis LJ. Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period. Cochrane Database Syst Rev 2002;(2):CD001689.

    Google Scholar 

  19. Noble SI, Hood K, Finlay IG. The use of long-term low-molecular weight heparin for the treatment of venous thromboembolism in palliative care patients with advanced cancer: a case series of sixty two patients. Palliat Med 2007;21(6):473–476.

    Article  PubMed  CAS  Google Scholar 

  20. Rodger MA, Kahn SR, Cranney A, Hodsman A, Kovacs MJ, Clement AM et al. Long-term dalteparin in pregnancy not associated with a decrease in bone mineral density: substudy of a randomized controlled trial. J Thromb Haemost 2007;5(8):1600–1606.

    Article  PubMed  CAS  Google Scholar 

  21. Lee AY, Levine MN, Baker RI, Bowden C, Kakkar AK, Prins M et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003;349(2):146–153.

    Article  PubMed  CAS  Google Scholar 

  22. Monreal M, Zacharski L, Jimenez JA, Roncales J, Vilaseca B. Fixed-dose low-molecular-weight heparin for secondary prevention of venous thromboembolism in patients with disseminated cancer: a prospective cohort study. J Thromb Haemost 2004;2(8):1311–1315.

    Article  PubMed  CAS  Google Scholar 

  23. Meyer G, Marjanovic Z, Valcke J, Lorcerie B, Gruel Y, Solal-Celigny P et al. Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study. Arch Intern Med 2002;162(15):1729–1735.

    Article  PubMed  CAS  Google Scholar 

  24. Deitcher SR, Kessler CM, Merli G, Rigas JR, Lyons RM, Fareed J. Secondary prevention of venous thromboembolic events in patients with active cancer: enoxaparin alone versus initial enoxaparin followed by warfarin for a 180-day period. Clin Appl Thromb Hemost 2006;12(4):389–396.

    Article  PubMed  CAS  Google Scholar 

  25. Hull RD, Pineo GF, Brant RF, Mah AF, Burke N, Dear R et al. Long-term low-molecular-weight heparin versus usual care in proximal-vein thrombosis patients with cancer. Am J Med 2006;119(12):1062–1072.

    Article  PubMed  CAS  Google Scholar 

  26. Baglin TP, Keeling DM, Watson HG. Guidelines on oral anticoagulation (warfarin): third edition–2005 update. Br J Haematol 2006;132(3):277–285.

    Article  PubMed  CAS  Google Scholar 

  27. Wagman LD, Baird MF, Bennett CL, Bockenstedt PL, Cataland SR, Fanikos J et al. Venous thromboembolic disease. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 2006;4(9):838–869.

    PubMed  CAS  Google Scholar 

  28. Lyman GH, Khorana AA, Falanga A, Clarke-Pearson D, Flowers C, Jahanzeb M et al. American Society of Clinical Oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer. J Clin Oncol 2007;25(34):5490–5505.

    Article  PubMed  CAS  Google Scholar 

  29. Aujesky D, Smith KJ, Cornuz J, Roberts MS. Cost-effectiveness of low-molecular-weight heparin for secondary prophylaxis of cancer-related venous thromobembolism. Thromb Haemost 2005;93:592–99.

    PubMed  CAS  Google Scholar 

  30. The van Gogh Investigators. Extended prophylaxis of venous thromboembolism with idraparinux. N Engl J Med 2007;357:1105–1112.

    Article  Google Scholar 

  31. Luk C, Wells PS, Anderson D, Kovacs MJ. Extended outpatient therapy with low molecular weight heparin for the treatment of recurrent venous thromboembolism despite warfarin therapy. Am J Med 2001;111(4):270–273.

    Article  PubMed  CAS  Google Scholar 

  32. Getzen TM, Rectenwald JE. Inferior vena cava filters in the cancer patient: current use and indications. J Natl Compr Canc Netw 2006;4(9):881–888.

    PubMed  Google Scholar 

  33. Decousus H, Leizorovicz A, Parent F, Page Y, Tardy B, Girard P et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prevention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group [see comments]. N Engl J Med 1998;338(7):409–415.

    Article  PubMed  CAS  Google Scholar 

  34. Decousus H. Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d'Embolie Pulmonaire par Interruption Cave) randomized study. Circulation 2005;112(3):416–422.

    Google Scholar 

  35. White RH, Zhou H, Kim J, Romano PS. A population-based study of the effectiveness of inferior vena cava filter use among patients with venous thromboembolism. Arch Intern Med 2000;160(13):2033–2041.

    Article  PubMed  CAS  Google Scholar 

  36. Elting LS, Escalante CP, Cooksley C, Avritscher EB, Kurtin D, Hamblin L et al. Outcomes and cost of deep venous thrombosis among patients with cancer. Arch Intern Med 2004;164(15):1653–1661.

    Article  PubMed  Google Scholar 

  37. Jarrett BP, Dougherty MJ, Calligaro KD. Inferior vena cava filters in malignant disease. J Vasc Surg 2002;36(4):704–707.

    PubMed  Google Scholar 

  38. Noble SIR, Finlay IG. Is long-term low-molecular-weight heparin acceptable to palliative care patients in the treatment of cancer related venous thromboembolism? A qualitative study. Palliat Med 2005;19(3):197–201.

    Article  PubMed  Google Scholar 

  39. Hull RD, Pineo GF, Mah AF, Brant RF. For the LITE Study Investigators. Long-term out-of-hospital treatment with low-molecular-weight heparin versus warfarin sodium: a randomized trial comparing the quality of life associated with these antithrombotic therapies. Blood 2001;98(11):267a.

    Google Scholar 

  40. Hull RD, Pineo GF, Mah AF, Brant RF. For the LITE Study Investigators. A randomized trial evaluating long-term low-molecular-weight heparin therapy out-of-hospital verus warfarin sodium comparing the post-phlebitic outcomes at three months. Blood 2001;98:447a.

    Google Scholar 

  41. Rickles FR, Shoji M, Abe K. The role of the hemostatic system in tumor growth, metastasis, and angiogenesis: tissue factor is a bifunctional molecule capable of inducing both fibrin deposition and angiogenesis in cancer. Int J Hematol 2001;73(2):145–150.

    Article  PubMed  CAS  Google Scholar 

  42. Altinbas M, Coskun HS, Er O, Ozkan M, Eser B, Unal A et al. A randomized clinical trial of combination chemotherapy with and without low-molecular-weight heparin in small cell lung cancer. J Thromb Haemost 2004;2(8):1266–1271.

    Article  PubMed  CAS  Google Scholar 

  43. Kakkar AK, Levine MN, Kadziola Z, Lemoine NR, Low V, Patel HK et al. Low molecular weight heparin therapy with dalteparin and survival in advanced cancer: the Fragmin Advanced Malignancy Outcome Study (FAMOUS). J Clin Oncol 2004;22(10):1944–1948.

    Article  PubMed  CAS  Google Scholar 

  44. Klerk CP, Smorenburg SM, Otten HM, Lensing AW, Prins MH, Piovella F et al. The effect of low molecular weight heparin on survival in patients with advanced malignancy. J Clin Oncol 2005;23(10):2130–2135.

    Article  PubMed  CAS  Google Scholar 

  45. Lee AY, Rickles FR, Julian JA, Gent M, Baker RI, Bowden C et al. Randomized comparison of low molecular weight heparin and coumarin derivatives on the survival of patients with cancer and venous thromboembolism. J Clin Oncol 2005;23(10):2123–2129.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Agnes Y. Y. Lee .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Lee, A.Y.Y. (2009). Treatment of Venous Thrombosis. In: Kwaan, H., Green, D. (eds) Coagulation in Cancer. Cancer Treatment and Research, vol 148. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-79962-9_14

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-79962-9_14

  • Published:

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-0-387-79961-2

  • Online ISBN: 978-0-387-79962-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics