The treatment of venous thromboembolism in patients with cancer

Venous thromboembolism (VTE) is a frequent complication in cancer patients, and represents an important cause of morbidity and mortality. Especially in those patients who have a poor life expectancy, preventing death from pulmonary embolism is the mainstay of treatment. Critically ill patients should promptly be administered thrombolytic drugs. Except for selected patients requiring aggressive therapy, the initial VTE treatment should be conducted with adjusted-dose unfractionated heparin, fixed-dose low-molecular-weight heparin (LMWH) or fondaparinux. LMWHs and fondaparinux have the potential to greatly simplify the initial treatment of VTE, making the treatment of suitable patients feasible in an outpatient setting. During anticoagulant therapy, cancer patients have a twofold to fourfold higher risk of recurrent VTE and major bleeding complications when compared to non-cancer patients. The long-term administration of LMWH should be considered as an alternative to anti-vitamin K drugs in patients with advanced disease and in those with conditions limiting the use of oral anticoagulants. Prolongation of anticoagulation should be considered for as long as the malignant disorder is active.