Prevention of venous thromboembolism in the cancer surgery patient

Cleve Clin J Med. 2008 Apr:75 Suppl 3:S17-26. doi: 10.3949/ccjm.75.suppl_3.s17.

Abstract

Cancer patients, especially those undergoing surgery for cancer, are at extremely high risk for developing venous thromboembolism (VTE), even with appropriate thromboprophylaxis. Anticoagulant prophylaxis in cancer surgery patients has reduced the incidence of VTE events by approximately one-half in placebo-controlled trials, and extended prophylaxis (for up to 1 month) has also significantly reduced out-of-hospital VTE events in clinical trials in this population. Clinical trials show no difference between low-molecular-weight heparin (LMWH) and unfractionated heparin in VTE prophylaxis efficacy or bleeding risk in this population, although the incidence of heparin-induced thrombocytopenia is lower with LMWH. The risk-benefit profile of low-dose anticoagulant prophylaxis appears to be favorable even in many cancer patients undergoing neurosurgery, for whom pharmacologic VTE prophylaxis has been controversial because of bleeding risks.

Publication types

  • Review

MeSH terms

  • Fondaparinux
  • Heparin, Low-Molecular-Weight / therapeutic use
  • Humans
  • Neoplasms / surgery*
  • Polysaccharides / therapeutic use
  • Postoperative Complications / prevention & control*
  • Risk Assessment
  • Risk Factors
  • Risk Reduction Behavior
  • Venous Thromboembolism / etiology
  • Venous Thromboembolism / prevention & control*
  • Warfarin / therapeutic use

Substances

  • Heparin, Low-Molecular-Weight
  • Polysaccharides
  • Warfarin
  • Fondaparinux