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ASCO Educational Book; 2008
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Anticoagulation in the Treatment of Venous Thromboembolism in Patients with Cancer

Anna Falanga, MD§, Agnes Y. Y. Lee, MD, MSc, FRCP(C)*, Michael B. Streiff, MD{dagger}, and Gary H. Lyman, MD, MPH{ddagger}

From the * Department of Medicine, McMaster University, Hamilton, Ontario, Canada; {dagger} Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; {ddagger} Department of Medicine, Duke University School of Medicine, and the Duke Comprehensive Cancer Center, Durham, NC; § Department of Hematology-Oncology, Ospedali Riuniti di Bergamo, Bergamo, Italy

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

Address reprint requests to Gary H. 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 major cause of morbidity and mortality in patients with cancer. Hence, it is essential that oncologists and other health providers are able to diagnose deep vein thrombosis (DVT) and pulmonary embolism (PE) accurately and administer effective treatment for these common vascular complications. Diagnosis of venous thromboembolism (VTE) in patients with cancer entails a comprehensive evaluation of relevant VTE risk factors, clinical signs, and symptoms culminating in an assessment of the probability of disease and need for radiologic testing. Acute therapy options for VTE include unfractionated heparin, low molecular weight heparin (LMWH), or fondaparinux. In most instances, LMWH therapy is preferred because it is recommended for long-term therapy and allows outpatient management. Management issues with absent or weak data include optimal duration of therapy, treatment of recurrent VTE, the role of vena cava filters, and the effects of VTE and its treatment on quality of life. Recent ASCO guidelines offer recommendations for pharmacologic or nonpharmacologic prophylaxis of VTE in patients with cancer in several situations. The existing data addressing these issues are limited, and there is a need for further research by large randomized controlled clinical trials. Newer anticoagulants hold promise in providing more effective and convenient treatment of VTE for this high-risk population, but properly designed clinical studies are awaited.