Anticoagulation for prevention and treatment of cancer-related venous thromboembolism

The close relationship between malignancy and venous thromboembolism (VTE) is well established, with malignancy increasing VTE risk and accounting for a substantial proportion of presentations with VTE. Moreover, VTE impacts significantly on morbidity and mortality in cancer patients. Anticoagulation for prevention and treatment of VTE requires a patient-centred approach due to the heterogeneous patient population and inherent increased thrombotic and bleeding risks. In recent years, low molecular weight heparin (LMWH) injections have come to be the mainstay for treatment and prevention of cancer-related VTE. For treatment, this is usually administered for at least 6 months and continued in patients with active cancer or those receiving treatment for cancer. The use of LMWH for thromboprophylaxis in hospitalised cancer patients is also well accepted, but out-of-hospital prophylaxis remains contentious. The development of risk assessment models may help identify the patients at highest risk. The role of the new oral factor Xa and thrombin inhibitors in this setting remains to be determined.