Treatment of venous thromboembolism in cancer patients

The occurrence of venous thromboembolism complicates the management of the patient with malignant disease because of the need for anticoagulant therapy. Cancer patients have an ongoing thrombotic stimulus due to the underlying cancer and its associated treatments, but are also considered to be at increased risk for anticoagulant-related bleeding. In recent years, the results of clinical trials have demonstrated the safety and efficacy of weight-adjusted subcutaneous low molecular weight heparin, administered at home, for patients with acute deep vein thrombosis. This approach is particularly attractive to patients with cancer where quality of life is an important consideration. There are no trials that specifically address the question of the duration of oral anticoagulant therapy in cancer patients. However, data can be extrapolated from trials evaluating the duration of oral anticoagulant therapy in other high-risk patients. Hence, cancer patients should continue oral anticoagulant therapy for as long as the cancer remains active (usually at least 6 months). There still remain a number of unanswered questions about the clinical management of thromboembolism in the cancer patient.