Low-molecular-weight heparin in the management of Trousseau's syndrome

Thrombophlebitis migrans is a major cause of morbidity in approximately 11% of patients with cancer. Thrombosis may predate the appearance of malignancy, and patients with thrombosis often respond poorly to warfarin.

Four patients with extensive thrombosis and cancer are described in this article. Enoxaparin, a low-molecular-weight heparin, was administered subcutaneously to these patients for 5, 6, 26, and 27 months, respectively. The literature on the management of Trousseau's syndrome was reviewed and analyzed.

All four patients remained free of venous thromboembolism while being treated with low-molecular-weight heparin, acutely and during follow-up. Previously published studies suggest that therapy with low-molecular-weight heparin results in lower mortality than standard heparin therapy.

Further study to evaluate the safety and efficacy of low-molecular-weight heparin for both prophylaxis and treatment of thromboembolism in association with malignancy may lead to decreased morbidity and better quality of life for patients with this disorder.