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Cancer and Thrombosis: Mechanisms and Treatment

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Abstract

Standard venous thromboembolic event (VTE) treatment practices including the use of intravenous unfractionated heparin (UFH) for initial anticoagulation, oral warfarin for chronic anticoagulation, and the prescription of only 3 to 6 months total therapy may not be optimal in the setting of active cancer and ongoing anti-cancer therapy. Challenges of VTE management in cancer patients include heparin resistance due to excess circulating acute-phase proteins, increased recurrence rates during and following standard-intensity warfarin therapy, limited venous access to support therapeutic monitoring, and anticoagulation intensity-independent increased bleeding rates during anticoagulation. Bleeding during anticoagulation is of particular concern in the treatment of cancer patients with disease- or chemotherapy-related thrombocytopenia, central nervous system involvement, or recent invasive procedures. Low-molecular weight heparins (LMWH) have been shown to be at least as effective and safe for initial anticoagulation compared with UFH in persons with acute VTE and have gained popularity in the setting of VTE in cancer. LMWHs have the advantage of less non-specific protein binding, subcutaneous weight-based dosing without the need for monitoring in most cases, and probably less heparin-induced thrombocytopenia. Recent trials have demonstrated efficacy superiority of select LMWHs in place of oral warfarin for long-term anticoagulation in the cancer patient. The potential for anti-tumor effects and a survival advantage associated with select classes of anticoagulant agents is actively being investigated.

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References

  1. Prandoni P, Piccioli A, Girolami A. Cancer and venous thromboembolism: An overview. Haematologica 1999;84:437-445.

    Google Scholar 

  2. Brill-Edwards P, Ginsberg JS, Johnston M, Hirsh J. Establishing a therapeutic range for heparin therapy. Ann Intern Med 1993;119:104-109.

    Google Scholar 

  3. Hansson PO, Welin L, Tibblin G, et al. Deep vein thrombosis and pulmonary embolism in the general population. 'The Study of Men Born in 1913'. Arch Intern Med 1997;157:1665-1670.

    Google Scholar 

  4. Sorensen HT, Mellemkjaer L, Steffensen FH, Olsen JH, Nielsen GL. The risk of a diagnosis of cancer after primary deep venous thrombosis or pulmonary embolism. N Engl J Med 1998;338:1169-1173.

    Google Scholar 

  5. Kakkar VV, Howe CT, Nicolaides AN, Renney JT, Clarke MB. Deep vein thrombosis of the leg. Is there a "high risk" group? Am J Surg 1970;120:527-530.

    Google Scholar 

  6. Walsh JJ, Bonnar J, Wright FW. A study of pulmonary embolism and deep leg vein thrombosis after major gynaecological surgery using labeled fibrinogen-phlebography and lung scanning. J Obstet Gynaecol Br Commonw 1974;81:311-316.

    Google Scholar 

  7. Piccioli A, Prandoni P, Ewenstein BM, Goldhaber SZ.Cancer and venous thromboembolism. Am Heart J 1996;132:850-855.

    Google Scholar 

  8. Luzzatto G, Schafer AI. The prothrombotic state in cancer.Semin Oncol 1990;17:147-159.

    Google Scholar 

  9. Gomes MPV, Deitcher SR. Diagnosis of Venous thromboembolic disease in cancer patients. Oncology 2003;17: 126-135.

    Google Scholar 

  10. Deitcher SR, Goldman CK, Ruiter K. Vascular endothelial growth factor (VEGF) levels in patients with idiopathic acute proximal deep venous thrombosis. Thromb Haemost 2001;86(Suppl):P1517.

    Google Scholar 

  11. 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;344:626-631.

    Google Scholar 

  12. Krauth D, Holden A, Knapic N, Liepman M, Ansell J.Safety and efficacy of long-term oral anticoagulation in cancer patients. Cancer 1987;59:983-985.

    Google Scholar 

  13. Heit JA, Mohr DN, Silverstein MD, Petterson TM, O'Fallon WM, Melton LJ. Predictors of recurrence after deep vein thrombosis and pulmonary embolism. A population-based cohort study. Arch Intern Med 2000;160: 761-768.

    Google Scholar 

  14. Hansson PO, Sorbo J, Eriksson H. Recurrent venous thromboembolism after deep vein thrombosis incidence and risk factors. Arch Intern Med 2000;160:769-774.

    Google Scholar 

  15. Prandoni P, Lensing AW, Cogo A, et al. The long term clinical course of acute deep venous thrombosis. Ann Intern Med 1996;125:1-7.

    Google Scholar 

  16. Prandoni P. Antithrombotic strategies in patients with cancer. Thromb Haemost 1997;78:141-144.

    Google Scholar 

  17. Prandoni P, Lensing AW, Piccioli A, et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 2002;100:3484-3488.

    Google Scholar 

  18. Hutten BA, Prins MH, Gent M, Ginsberg J, Tijssen JGP, Buller HR. Incidence of recurrent thromboembolic and bleeding complications among patients with venous thromboembolism in relation to both malignancy and achieve international normalized ratio: A retrospective analysis. J Clin Oncol 2000;8:3078-3083.

    Google Scholar 

  19. Levitan N, Dowlati A, Remick SC, et al. Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy: Risk analysis using Medicare claims data. Medicine 1999;78:285-291.

    Google Scholar 

  20. Ottinger H, Belka C, Kozole G, et al. Deep venous thrombosis and pulmonary embolism in high-grade non Hodgkin's lymphoma: Incidence, causes and prognostic relevance. Eur J Haematol 1995;54:186-194.

    Google Scholar 

  21. Levine MN. Prevention of thrombotic disorders in cancer patients undergoing chemotherapy. Thromb Haemost 1997;78:133-136.

    Google Scholar 

  22. Edwards RL, Silver J, Rickles FR. Human tumor procoagulants: Registry of the subcommittee on haemostasis and malignancy of the scientific and standardization committee, international society on thrombosis and haemostasis.Thromb Haemost 1993;69:205-213.

    Google Scholar 

  23. Falanga A, Donati MB. Pathogenesis of thrombosis in patients with malignancy. Int J Hematol 2001;73:137-144.

    Google Scholar 

  24. Gordon S. Cancer cell procoagulants and their implications.Hematol Oncol Clin North Am 1992;6:1359-1374.

    Google Scholar 

  25. Rickles FR, Hair GA, Zeff RA, Lee E, Bona RD. Tissue factor expression in human leukocytes and tumor cells.Thromb Haemost 1995;74:391-395.

    Google Scholar 

  26. Bevilacqua MP, Pober JS, Majeau GR, Fiers W, Cotran RS, Gimbrone MA. Recombinant tumor necrosis factor induces procoagulant activity in cultured human vascular endothelium: Characterization and comparison with the actions of interleukin-1. Proc Natl Acad Sci USA 1996;83:4533-4537.

    Google Scholar 

  27. Deitcher SR, Carman TL, Sheikj M, Gomes M. Hypercoagulable syndromes: Evaluation and management strategies in acute limb ischemia. Semin Vasc Surg 2001;14:74-85.

    Google Scholar 

  28. Deitcher SR, Lucore C, Eisenberg PR. Impaired resolution of a massive pulmonary embolus associated with an impaired fibrinolytic response. Am J Med 1994;96:483-484.

    Google Scholar 

  29. Deitcher SR, Erban JK, Limentani SA. Acquired free protein S deficiency asociated with multiple myeloma. Am J Hematol 1996;51:319-323.

    Google Scholar 

  30. Fareed J, Hoppensteadt D, Lietz H, Tobu M, Cort S, Deitcher S. Multifactorial etiology of cancer associated venous thrombosis: Results from the baseline profiling of cancer patients recruited in a study for the secondary prevention of venous thrombosis with a low molecular weight heparin (ONCENOX). Proceedings of the American Society of Clinical Oncology 2003;22:741 (abstract 2979).

    Google Scholar 

  31. Beer JH, Haeberli A, Vogt A, et al. Coagulation markers predict survival in cancer patients. Thromb Haemost 2002;88:745-749.

    Google Scholar 

  32. Anderson AJ, Krasnow SH, Boyer MW, et al. Thrombosis: The major Hickman catheter complication in patients with solid tumor. Chest 1989;95:71-75.

    Google Scholar 

  33. Bona RD. Thrombotic complication of central catheters in cancer patients. Semin Thromb Hemostasis 1999;25:147-157.

    Google Scholar 

  34. Gould JR, Carloss HW, Skinner WL. Groshong catheterassociated subclavian venous thrombosis. Am J Med 1993;95:419-423.

    Google Scholar 

  35. Kee ST, Kinoshita L, Razavi MK, Nyman CP, Semba CP, Dake MD. Superior vena cava syndrome: Treatment with catheter-directed thrombolysis and endovascular stent placement. Radiology 1998;206:187-193.

    Google Scholar 

  36. Patel V, Igwebe T, Mast H, Karetzky MS. Superior vena cava syndrome; current concepts of management. New Jersey Medicine 1995;92:245-248.

    Google Scholar 

  37. Prandoni P, Polistena P, Bernardi E, et al. Upper extremity deep vein thrombosis. Risk factors, diagnosis, and complications.Arch Intern Med 1997;157:57-62.

    Google Scholar 

  38. Raad II, Luna M, Khalil SA, Costerton JW, Lam C, Bodey GP. The relationship between the thrombotic and infectious complications of central venous catheters. JAMA 1994;271:1014-1016.

    Google Scholar 

  39. Goodnough LT, Saito H, Manni A, Jones PK, Pearson OH. Increased incidence of thromboembolism in stage-4 breast cancer patients treated with a five-drug chemotherapy regimen: A study of 159 patients. Cancer 1984;54:1264-1268.

    Google Scholar 

  40. Gail MH, Costantino JP, Bryant J, et al. Weighing the risks and benefits of tamoxifen treatment for preventing breast cancer. J Natl Cancer Inst 1999;91:1829-1846.

    Google Scholar 

  41. Saphner T, Tormey DC, Gray R. Venous and arterial thrombosis in patients who received adjuvant therapy for breast cancer. J Clin Oncol 1991;9:286-294.

    Google Scholar 

  42. Levine MN, Gent M, Hirsh J, et al. The thrombogenic effect of anticancer drug therapy in women with stage-2 breast cancer. N Engl J Med 1988;318:404-407.

    Google Scholar 

  43. Pritchard KI, Paterson AH, Paul NA, Zee B, Fine S, Pater J. Increased thromboembolic complications with concurrent tamoxifen and chemotherapy in a randomized trial of adjuvant therapy for women with breast cancer. National Cancer Institute of Canada Clinical Trials Group Breast Cancer Site Group. J Clin Oncol 1996;14:2731-2737.

    Google Scholar 

  44. Zangari M, Siegel E, Anaissie E, et al. Risk factors for deep vein thrombosis in a large group of myeloma patients treated with thalidomide: The Arkansas Experience.Blood 2001;98:161a.

    Google Scholar 

  45. Zangari M, Anaissie E, Barlogie B, et al. Increased risk of deep-vein thrombosis in patients with multiple myeloma receiving thalidomide and chemotherapy. Blood 2001;98(5):1614-1615.

    Google Scholar 

  46. Hoppensteadt D, Fareed J, Lietz H, Tobu M, Cort S, Deitcher S. Malignancy related thrombotic state is independent of defects in factor V Leiden, prothrombin 20210 and MTHFR. Results from the initial profiling of cancer patients enrolled in the ONCENOX trial. Proceedings of the American Society of Clinical Oncology 2003;22:861 (abstract 3461).

    Google Scholar 

  47. Deitcher SR, Carman TL. Deep venous thrombosis and pulmonary embolism. Current Treatment Options in Cardiovascular Medicine 2002;4:223-238.

    Google Scholar 

  48. Scates SM. Diagnosis and treatment of cancer-related thrombosis. Hematol Oncol Clin North Am 1992;6:1329-1339.

    Google Scholar 

  49. Deitcher SR. Cancer-related deep venous thrombosis: Clinical importance, treatment challenges, and management strategies. Semin Thromb Haemost 2003;29:247-258.

    Google Scholar 

  50. Hirsh J, Warkentin TW, Shaughnessy SG, et al. Heparin and low-molecular-weight heparin; mechanisms of action pharmacokinetics, dosing considerations, monitoring, ef-ficacy, and safety. Chest 2001;119(Suppl):64S-94S.

    Google Scholar 

  51. Levine MN, Hirsh J, Gent M, et al. A randomized trial comparing activated thromboplastin time with heparin assay in patients with acute venous thromboembolism requiring large daily doses of heparin. Arch Intern Med 1994;154:49-56.

    Google Scholar 

  52. Chan A, Woodruff RK. Complications and failure of anticoagulation therapy in treatment of venous thromboembolism in patients with disseminated malignancy. Aust NZ J Med 1992;22:119-122.

    Google Scholar 

  53. Bona RD, Sivjee KY, Hickey AD, Wallace SB, Wajcs SB.The efficacy and safety of oral anticoagulation in patients with cancer. Thromb Haemostasis 1995;74:1055-1058.

    Google Scholar 

  54. Bona RD, Hickey AD, Wallace DM. Efficacy and safety of oral anticoagulation in patients with cancer. Thromb Haemostasis 1997;78:137-140.

    Google Scholar 

  55. Gitter MJ, Jaeger TM, Petterson TM, Gersh MD, Silverstein MD. Bleeding and thromboembolism during anticoagulant therapy: A population-based study in Rochester, Minnesota. Mayo Clin Proc 1995;70:725-733.

    Google Scholar 

  56. Wester JPJ, de Valk HW, Nieuwenhuis HK, et al. Risk factors for bleeding during treatment of acute venous thromboembolism.Thromb Haemostasis 1996;76:682-688.

    Google Scholar 

  57. Carman TL, Kanner AA, Barnett GH, Deitcher SR. Neurosurgery thromboprophylaxis following tumor surgery: A survey. Southern Med J 2003;96:17-22.

    Google Scholar 

  58. Altschuler E, Moosa H, Selker RG, Vertosick FT. The risk and efficacy of anticoagulant therapy in the treatment of thromboembolic complications in patients with primary malignant brain tumors. Neurosurgery 1990;27:74-77.

    Google Scholar 

  59. Choucair AK, Silver P, Levin VA. Risk of intracranial hemorrhage in glioma patients receiving anticoagulant therapy for venous thromboembolism. J Neurosurg 1987;66:357-358.

    Google Scholar 

  60. Norris LK, Grossman SA. Treatment of thromboembolic complications in patients with brain tumors. J Neuro-Oncol 1994;22:127-137.

    Google Scholar 

  61. Olin JW, Young JR, Graor RA, Ruschhaupt EG, Beven EG, Bay JW. Treatment of deep vein thrombosis and pulmonary emboli in patients with primary and metastatic brain tumors. Arch Intern Med 1987;147: 2177-2179.

    Google Scholar 

  62. Ruff RL, Posner JB. Incidence and treatment of peripheral venous thrombosis in patients with glioma. Ann Neurol 1983;13:334-336.

    Google Scholar 

  63. Schiff D, DeAngelis LM. Therapy of venous thromboembolism in patients with brain metastases. Cancer 1994;73:493-498.

    Google Scholar 

  64. Levine M, Gent M, Hirsch 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.NEngl JMed 1996;334:677-681.

    Google Scholar 

  65. Koopman MM, Prandoni P, Piovella F, 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. N Engl J Med 1996;334:682-687.

    Google Scholar 

  66. Hull RD, Raskob GL, Pineo GF, et al. Subcutaneous low-molecular-weight heparin compared with continuous intravenous heparin in the treatment of proximal vein thrombosis. N Engl J Med 1992;326:975-982.

    Google Scholar 

  67. Lindmarker P, Holmstrom M, Granqvist S, et al. Comparison of once-daily subcutaneous Fragmin with continuous intravenous unfractionated heparin in the treatment of deep vein thrombosis. Thromb Haemost 1994;72:186-190.

    Google Scholar 

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

    Google Scholar 

  69. Weitz JI. Low molecular weight heparins. N Engl J Med 1995;337:688-698.

    Google Scholar 

  70. Warkentin TE, Levine MN, Hirsh J, et al. Heparininduced thrombocytopenia in patients treated with lowmolecular-weight heparin or unfractionated heparin. N Engl J Med 1995;332:1330-1335.

    Google Scholar 

  71. Muir JM, Hirsh J, Weitz JI, Andrew M, Young E, Shaughnessy SG. A histomorphometric comparison of the effects of heparin and low molecular weight heparin on cancellous bone in rats. Blood 1997;89:3236-3242.

    Google Scholar 

  72. Bhandari M, Hirsh J, Weitz J, et al. The effects of standard and low molecular weight heparin on bone nodule formation in vitro. Thromb Haemost 1998;80:413-417.

    Google Scholar 

  73. Lensing AW, Prins MH, Davidson BL, Hirsh J. Treatment of deep venous thrombosis with low molecular weight heparins. A meta-analysis. Arch Intern Med 1995;155:601-607.

    Google Scholar 

  74. Siragusa S, Cosmi B, Piovella, Hirsh J, Ginsberg JS.Low molecular weight heparins and unfractionated heparin in the treatment of patient with acute venous thromboembolism; results of a meta-analysis. Am J Med 1996;100:269-277.

    Google Scholar 

  75. Gould MK, Dembitzer AD, Doyle RL, Hastie TJ, Garber AM. Low-molecular-weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis: A meta-analysis of randomized, controlled trails. Ann Intern Med 1999;130:800-809.

    Google Scholar 

  76. Dolovich LR, Ginsberg JS, Douketis JD, Holbrook AM, Cheah G. A meta-analysis comparing low-molecularweight heparins with unfractionated heparin in the treatment of venous thromboembolism: Examining some unanswered questions regarding location of treatment, product type, and dosing frequency. Arch Intern Med 2000;160:181-188.

    Google Scholar 

  77. Green D, Hull RD, Brant R, Pineo GF. Lower mortality in cancer patients treated with low-molecular-weight versus standard heparin. Lancet 1992;339:1476.

    Google Scholar 

  78. Folkman J, Langer R, Linhardt RJ, Haudenschild C, Taylor S. Angiogenesis inhibition and tumour regression caused by heparin or heparin fragment in the presence of cortisone. Science 1983;221:719-725.

    Google Scholar 

  79. Norrby K. Heparin and angiogenesis: A low-molecularweight fraction inhibits and a high-molecular-weight fraction stimulates angiogenesis systematically.Haemostasis 1993;23(Suppl):141-149.

    Google Scholar 

  80. Kakkar AK, Kadziola Z, Williamson RCN, Levine MN, Low V, Lemoine NR. Low molecular weight heparin therapy and survival in advanced cancer. Blood 2002;100:148a (abstract 557).

    Google Scholar 

  81. Lee AY, Julian JA, Levine MN, et al. Impact of dalteparin low-molecular-weight heparin (LMWH) on survival: Results of a randomized trial in cancer patients with venous thromboembolism (VTE). Proceedings of the American Society of Clinical Oncology 2003;22:211 (abstract 846).

    Google Scholar 

  82. Anand SS, Bates S, Ginsberg JS, et al. Recurrent venous thrombosis and heparin therapy; an evaluation of the importance of early activated partial thromboplastin times.Arch Intern Med 1999;159:2029-2032.

    Google Scholar 

  83. Hull RD, Raskob GE, Brant RF, Pineo GF, Valentine KA.Relation between the time to achieve the lower limit of the APTT therapeutic range and recurrent venous thromboembolism during heparin treatment for deep vein thrombosis. Arch Intern Med 1997;157:2562-2568.

    Google Scholar 

  84. Hull RD, Raskob GE, Brant RF, et al. The importance of initial heparin treatment on long-term clinical outcomes of antithrombotic therapy: The emerging theme of delayed recurrence. Arch Intern Med 1997;157:2317-2321.

    Google Scholar 

  85. Raschke RA, Reilly BM, Guidry JR, et al. The weightbased heparin dosing nomogram compared with a standard care nomogram: A randomized, controlled trial. Ann Intern Med 1993;119:874-881.

    Google Scholar 

  86. Merli G, Spiro TE, Olsson C-G, et al. Subcutaneous enoxaparin once or twice daily compared with intravenous unfractionated heparin for treatment of venous thromboembolic disease. Ann Intern Med 2001;134:191-202.

    Google Scholar 

  87. Hainer JW, Barrett JS, Assaid CA, et al. Dosing in heavyweight/ obese patients with the LMWH, tinzaparin: A pharmacodynamic study. Thromb Haemost 2002;87:817-823.

    Google Scholar 

  88. The Matisse Investigators. Fondaparinux (Arixtra) in comparison to (low molecular weight) heparin for the initial treatment of symptomatic deep venous thrombosis or pulmonary embolism–The Matisse Clinical Outcome Studies. Blood 2002;100: Abstract 302.

  89. Hirsh J, Dalen JE, Anderson D, et al. Oral anticoagulants: Mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest 2001;119(Suppl):8S-21S.

    Google Scholar 

  90. Moll S, Ortel TL. Monitoring warfarin therapy in patients with lupus anticoagulants. Ann Intern Med 1997;127:177-185.

    Google Scholar 

  91. Harrison L, Johnston M, Massicotte MP, Crowther M, Moffat K, Hirsh J. Comparison of 5-mg and 10-mg loading doses in initiation of warfarin therapy. Ann Intern Med 1997;126:133-136.

    Google Scholar 

  92. Choueiri T, Deitcher SR. Why shouldn't we solely usewarfarin to treat acute venous thrombosis? Cleve Clin J Med 2002;69:546-548.

    Google Scholar 

  93. Monreal M, Lafoz E, Olive A, del Rio L, Vedia C. Comparison of subcutaneous unfractionated heparin with a low molecular weight heparin (Fragmin) in patients with venous thromboembolism and contraindications to coumarin. Thromb Haemost 1994;71:7-11.

    Google Scholar 

  94. Pini M, Aiello S, Manotti C, et al. Low molecular weight heparin versus warfarin in the prevention of recurrences after deep vein thrombosis. Thromb Haemost 1994;72:191-197.

    Google Scholar 

  95. Das SK, Cohen AT, Edmondson RA, Melissari E, Kakkar VV. Low-molecular-weight heparin versus warfarin for prevention of recurrent venous thromboembolism: A randomized trial. World J Surg 1996;20:521-527.

    Google Scholar 

  96. Loaciuk S, Bielska-Falda H, Nosczyk W, et al. Low molecular weight heparin versus acenocoumarol in the secondary prophylaxis of deep vein thrombosis. Thromb Haemost 1999;81:26-31.

    Google Scholar 

  97. Hull RD, Pineo GF, Mah AF, Brant RF. A randomized trial evaluating long-term low-molecular-weight heparin therapy for three months versus intravenous heparin followed by warfarin sodium. Blood 2002;100:148a(abstract 556).

    Google Scholar 

  98. Gruel Y, Meyer G, Marjanovic Z, et al. Canthanox, a randomized controlled study comparing low molecular weight heparin and warfarin for the prevention of recurrent venous thromboembolism in patients with cancer.Blood 2001;98:707a.

    Google Scholar 

  99. Lee AY, Levine MN, Baker RI, et al. Low-molecularweight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer.N Engl J Med 2003;349:146-153.

    Google Scholar 

  100. Deitcher SR, Kessler CM, Merli G, Rigas J, Lyons RM, Cort S. Secondary prevention of venous thromboembolic events in patients with active malignancy: A randomized study of enoxaparin sodium alone versus initial enoxaparin sodium followed by warfarin for a 180-day period.N Engl J Med 1995;332:1661-1665.

    Google Scholar 

  101. Kearon C, Gent M, Hirsh J, et al. A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism.N Engl J Med 1999;340:901-907.

    Google Scholar 

  102. Schulman S, Granqvist S, Holström M, et al. The duration of oral anticoagulant therapy after a second episode of venous thromboembolism. N Engl J Med 1997;336:393-398.

    Google Scholar 

  103. Ridker PM, Goldhaber SZ, Danielson E, et al.Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med2003;348:1425-1434.

    Google Scholar 

  104. Schwarz RE, Marrero AM, Conlon KC, Burt M. Inferior vena cava filters in cancer patients: Indications and outcomes.J Clin Oncol 1996;14:652-657.

    Google Scholar 

  105. Ihnat DM, Mills JL, Hughes JD, Gentile AT, Berman SS, Westerband A. Treatment of patients with venous thromboembolism and malignant disease: Should vena cava filter placement be routine? J Vasc Surg 1998;28:800-807.

    Google Scholar 

  106. Streift MB. Vena cava filters: A comprehensive review.Blood 2000;95:3669-3677.

    Google Scholar 

  107. Athanasoulis CA, Kaufman JA, Halpern EF, Waltman AC, Geller SC, Fan CM. Inferior vena caval filters; a review of a 26-year single-centre clinical experience.Radiology 2000;21:54-66.

    Google Scholar 

  108. Millward SF, Peterson RA, Moher D, et al. LGM (Vena Tech) vena caval filter: Experience at a single institution.J Vasc Intervention Radiol 1994;5:351-356.

    Google Scholar 

  109. Decousus H, Leizorovicz A, Parent F, et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis.N Engl J Med 1998;338:409-415.

    Google Scholar 

  110. Hyers TM, Agnelli A, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease. Chest 2001;119(suppl):176S-193S.

    Google Scholar 

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  1. Section of Hematology and Coagulation Medicine, Department of Hematology and Medical Oncology, The Cleveland Clinic Foundation, Cleveland, OH, USA

    Steven R. Deitcher

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Deitcher, S.R. Cancer and Thrombosis: Mechanisms and Treatment. J Thromb Thrombolysis 16, 21–31 (2003). https://doi.org/10.1023/B:THRO.0000014589.17314.24

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