Home  |  About the Book  |  Table of Contents  |  Search  |  Order  |  Visit JCO  |  Visit ASCO.org
ASCO Educational Book; 2008
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar content in this book
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Francis, C. W.
Right arrow Articles by Lyman, G. H.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Francis, C. W.
Right arrow Articles by Lyman, G. H.

Prevention of Venous Thromboembolism in Patients with Cancer

Charles W. Francis, MD1, Ajay K. Kakkar, BSc, PhD, FRCP2, Mark N. Levine, MD3, and Gary H. Lyman, MD, MPH4

From the 1 Department of Medicine, University of Rochester Medical Center, Rochester, New York; 2 Thrombosis Research Institute, Barts and the London School of Medicine, Manresa Road, London, United Kingdom; 3 Juravinski Cancer Centre and the Department of Oncology, McMaster University, Henderson Research Centre, Hamilton, Ontario, Canada; 4 Department of Medicine, Duke University School of Medicine and the Duke Comprehensive Cancer Center, Durham, North Carolina

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

Address reprint requests to Gary Lyman, MD, MPH, Department of Medicine, Duke University School of Medicine and the Duke Comprehensive Cancer Center, 2424 Erwin Road, Box 602, Durham, NC 27705; e-mail: gary.lyman{at}duke.edu

Overview: Venous thromboembolism (VTE) is a frequent cause of morbidity and mortality among hospitalized patients, particularly those with cancer. The greatest risk of VTE is evident among older patients with cancer, specific types of cancers, in those with metastatic disease, and in those who are immobilized, neutropenic, and infected. Pharmacologic prophylaxis reduces the risk of VTE with minimal risk of bleeding. Although limited data are available on prophylaxis, specifically in patients with cancer, evidence supports prophylaxis in hospitalized patients with cancer. Patients with cancer undergoing surgical intervention also are at increased risk for VTE complications. Risk factors that further increase the risk in the surgical setting include older age, a previous history of VTE, prolonged surgery, advanced-stage disease, and prolonged bed rest following surgery. Unfortunately, there are little data on primary VTE prophylaxis in ambulatory patients with cancer, and routine prophylaxis with an antithrombotic agent is not recommended. However, patients receiving thalidomide or thalidomide analog with chemotherapy or dexamethasone are at sufficiently high risk for thrombosis and warrant prophylaxis. In the absence of data from controlled clinical trials, low-molecular-weight heparin or adjusted-dose warfarin (INR 1.5) is recommended for patients with multiple myeloma receiving thalidomide plus chemotherapy or dexamethasone.