Anticoagulant prophylaxis and therapy in patients with cancer

Due to the various reported mechanisms by which tumours may alter haemostasis directly or indirectly, a close relationship between tumour and thrombosis is convincing. As patients with cancer represent a diverse group, the establishment of general treatment guidelines concerning antithrombotic prophylaxis and therapy requires more data than are present to date. However, in cancer patients who are candidates for surgery, chemotherapy, indwelling central venous line, or prolonged immobility, primary prophylaxis is recommended. Patients with manifest thromboembolism should receive immediate treatment and a secondary prophylaxis for more than 3 months or at least as long as the cancer is active. In patients inappropriate for oral anticoagulation, the administration of LMWH is a suitable alternative. More prospective, randomized and larger studies are required to determine the optimally tailored primary prophylaxis, the best time to start and to stop treatment, to determine the best route, dosage and pharmacological antithrombotic, and to define the role of newer anticoagulants as hirudins in the anticoagulative prophylaxis and treatment of patients with cancer.