PMID- 14760208
OWN - NLM
STAT- MEDLINE
DCOM- 20041110
LR  - 20181113
IS  - 0929-5305 (Print)
IS  - 0929-5305 (Linking)
VI  - 16
IP  - 1-2
DP  - 2003 Aug-Oct
TI  - Cancer and thrombosis: mechanisms and treatment.
PG  - 21-31
AB  - Standard venous thromboembolic event (VTE) treatment practices including the use 
      of intravenous unfractionated heparin (UFH) for initial anticoagulation, 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 
      anti-cancer therapy. Challenges of VTE management in cancer patients include 
      heparin resistance due to excess circulating acute-phase proteins, increased 
      recurrence rates during and following standard-intensity warfarin therapy, 
      limited venous access to support therapeutic monitoring, and anticoagulation 
      intensity-independent increased bleeding rates during anticoagulation. Bleeding 
      during anticoagulation is of particular concern in the treatment of cancer 
      patients with disease- or chemotherapy-related thrombocytopenia, central nervous 
      system involvement, or recent invasive procedures. Low-molecular weight heparins 
      (LMWH) have been shown to be at least as effective and safe for initial 
      anticoagulation compared with UFH in persons with acute VTE and have gained 
      popularity in the setting of VTE in cancer. LMWHs have the advantage of less 
      non-specific protein binding, subcutaneous weight-based dosing without the need 
      for monitoring in most cases, and probably less heparin-induced thrombocytopenia. 
      Recent trials have demonstrated efficacy superiority of select LMWHs in place of 
      oral warfarin for long-term anticoagulation in the cancer patient. The potential 
      for anti-tumor effects and a survival advantage associated with select classes of 
      anticoagulant agents is actively being investigated.
FAU - Deitcher, Steven R
AU  - Deitcher SR
AD  - Section of Hematology and Coagulation Medicine, Department of Hematology and 
      Medical Oncology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA. 
      deitchs@ccf.org
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Netherlands
TA  - J Thromb Thrombolysis
JT  - Journal of thrombosis and thrombolysis
JID - 9502018
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Animals
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - Neoplasms/*blood/complications/*drug therapy
MH  - Thrombosis/*blood/complications/*drug therapy
RF  - 111
EDAT- 2004/02/05 05:00
MHDA- 2004/11/13 09:00
CRDT- 2004/02/05 05:00
PHST- 2004/02/05 05:00 [pubmed]
PHST- 2004/11/13 09:00 [medline]
PHST- 2004/02/05 05:00 [entrez]
AID - 5263860 [pii]
AID - 10.1023/B:THRO.0000014589.17314.24 [doi]
PST - ppublish
SO  - J Thromb Thrombolysis. 2003 Aug-Oct;16(1-2):21-31. doi: 
      10.1023/B:THRO.0000014589.17314.24.