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ASCO Educational Book; 2009
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Treatment of Venous Thromboembolism in Patients with Cancer

Agnes Y.Y. Lee, MD, MSc, FRCPC

From the Thrombosis Program, University of British Columbia and Vancouver Coastal Health, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada

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

Address reprint requests to Agnes Lee, MD, Diamond Health Care Centre, 2775 Laurel St, 10th Fl, Vancouver V5Z 1M9, BC, Canada; e-mail: alee14{at}bccancer.bc.ca

Overview: Venous thromboembolism (VTE) is a frequent and important cause of morbidity and mortality for patients with cancer.1 Thrombotic complications such as deep vein thrombosis and pulmonary embolism can delay or interfere with first-line anticancer therapy, precipitate or prolong hospitalization, and increase healthcare resource utilization. VTE is also an emotional and economic burden to the patients and their families, resulting in a negative effect on quality of life. Recent studies have shown a steady rise in the incidence of venous and arterial thrombotic events for patients with cancer, likely reflecting an aging population, an increase in awareness, and more effective and prothrombotic anticancer treatments.2,3

Despite these serious issues, treatment of VTE for patients with cancer remains poorly studied. In the past decade, few studies have evaluated the efficacy and safety of traditional anticoagulants, and clinical research investigating duration of therapy, prognostic stratification, and other interventions, such as vena cava filter insertion, is still lacking. Evidence-based guidelines support the use of low-molecular weight heparin as the preferred class of agents for the initial and long-term treatment of cancer-associated thrombosis, but therapeutic options remain limited. Novel oral anticoagulants may offer more effective and convenient strategies for minimizing the burden of VTE, but clinical trials evaluating these new agents must first be conducted in the unique and high-risk oncology population.