PMID- 12888929
OWN - NLM
STAT- MEDLINE
DCOM- 20040324
LR  - 20220409
IS  - 0094-6176 (Print)
IS  - 0094-6176 (Linking)
VI  - 29
IP  - 3
DP  - 2003 Jun
TI  - Cancer-related deep venous thrombosis: clinical importance, treatment challenges, 
      and management strategies.
PG  - 247-58
AB  - Venous thromboembolic disease (VTE), including deep venous thrombosis (DVT) and 
      pulmonary embolism (PE), is an underdiagnosed and underappreciated clinical 
      problem in cancer patients that results in significant patient morbidity and 
      mortality. Standard treatment practices, including the use of intravenous 
      unfractionated heparin (UFH) for initial anticoagulation, the use of oral 
      warfarin for chronic anticoagulation, and the prescription of only 3 to 6 months 
      total therapy, may not be optimal in the setting of active cancer and ongoing 
      anticancer therapy. Challenges of VTE management in cancer patients include 
      heparin resistance because of excess circulating acute phase proteins, increased 
      recurrence rates during warfarin therapy (target international normalized ratio 2 
      to 3), limited venous access to support therapeutic monitoring, and increased 
      bleeding rates during anticoagulation. Bleeding during anticoagulation is of 
      particular concern in patients with disease- or chemotherapy-related 
      thrombocytopenia, central nervous system involvement with cancer, and recent 
      surgical intervention. Low-molecular-weight heparins (LMWHs) have been shown to 
      be equally effective and safe for initial anticoagulation compared with UFH and 
      have gained popularity, especially in the setting of VTE in cancer. LMWHs have 
      the advantage of less nonspecific protein binding, subcutaneous weight-based 
      dosing without the need for monitoring in most cases, and less heparin-induced 
      thrombocytopenia. Recent clinical trials have shown LMWHs are at least as 
      effective as oral warfarin for long-term anticoagulation in cancer patients. 
      Interest in LMWHs and several new classes of parenteral and oral anticoagulants 
      extends beyond the primary and secondary prevention of VTE and includes 
      antiangiogenesis, metastasis prevention, and survival prolongation.
FAU - Deitcher, Steven R
AU  - Deitcher SR
AD  - Department of Hematology Medical Oncology, The Cleveland Clinic Foundation, 
      Cleveland, Ohio 44195, USA. deitchs@ccf.org
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Semin Thromb Hemost
JT  - Seminars in thrombosis and hemostasis
JID - 0431155
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Anticoagulants/adverse effects/therapeutic use
MH  - Disease Management
MH  - Humans
MH  - Neoplasms/*complications/drug therapy
MH  - Thrombophilia/drug therapy/etiology
MH  - Treatment Outcome
MH  - Venous Thrombosis/drug therapy/*etiology
RF  - 121
EDAT- 2003/07/31 05:00
MHDA- 2004/03/25 05:00
CRDT- 2003/07/31 05:00
PHST- 2003/07/31 05:00 [pubmed]
PHST- 2004/03/25 05:00 [medline]
PHST- 2003/07/31 05:00 [entrez]
AID - 10.1055/s-2003-40963 [doi]
PST - ppublish
SO  - Semin Thromb Hemost. 2003 Jun;29(3):247-58. doi: 10.1055/s-2003-40963.