PMID- 16286367
OWN - NLM
STAT- MEDLINE
DCOM- 20060117
LR  - 20190101
IS  - 1079-2082 (Print)
IS  - 1079-2082 (Linking)
VI  - 62
IP  - 22 Suppl 5
DP  - 2005 Nov 15
TI  - Considerations and challenges with existing treatments for thrombosis in cancer 
      patients.
PG  - S7-9
AB  - PURPOSE: One of the standard treatments for cancer-associated thrombosis has been 
      initial therapy with unfractionated heparin (UFH) followed by long-term therapy 
      with an oral anticoagulant (i.e., warfarin). However, characteristics associated 
      with these two agents may make them suboptimal for many cancer patients. This 
      article will explore some of the considerations and limitations when using UFH 
      and warfarin in the cancer population and will also utilize case studies to 
      emphasize the importance of individualized care. SUMMARY: UFH is an effective 
      anticoagulant when doses are adjusted to maintain the activated partial 
      thromboplastin time (aPTT) within a specified therapeutic range. However, due to 
      the complex pharmacokinetics of this agent, patients must undergo frequent 
      monitoring to maintain a therapeutic aPTT. In addition, UFH can be associated 
      with serious adverse events including osteoporosis, heparin-induced 
      thrombocytopenia, and bleeding. Similar to UFH, warfarin requires frequent 
      monitoring and dose adjustments to maintain the International Normalized Ratio 
      (INR) within the therapeutic range of 2.0 to 3.0. Warfarin also has numerous 
      drug-herbal, drug-food, and drug-drug interactions, including interactions with 
      many commonly used anti-tumor therapies. Complications related to UFH and 
      warfarin in the treatment of cancer-associated thrombosis have gradually been 
      minimized with the increased use of low molecular weight heparins (LMWHs), which 
      are associated with reduced incidence of bleeding, heparin-induced 
      thrombocytopenia, and drug interactions. In addition, LMWHs allow for convenient 
      daily dosing without requiring routine monitoring and the option of home therapy. 
      CONCLUSION: When deciding on the optimal anticoagulant strategy, pharmacists must 
      take into account the unique characteristics and needs of each individual patient 
      as well as the specifics of the various anticoagulant therapies. Future 
      strategies for the initial and long-term treatment of cancer-associated 
      thrombosis may increasingly incorporate LMWHs because of factors related to 
      safety and convenience.
FAU - Schwartz, Rowena N
AU  - Schwartz RN
AD  - University of Pittsburgh, UPMC Cancer Pavilion, Room 430, 5150 Centre Avenue, 
      Pittsburgh, PA 15232, USA. schwartzrn@upmc.edu
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - England
TA  - Am J Health Syst Pharm
JT  - American journal of health-system pharmacy : AJHP : official journal of the 
      American Society of Health-System Pharmacists
JID - 9503023
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/*therapeutic use
MH  - Bone Neoplasms/secondary
MH  - Breast Neoplasms/complications/pathology
MH  - Carcinoma, Non-Small-Cell Lung/complications
MH  - Fatigue/drug therapy/etiology
MH  - Female
MH  - Heparin/therapeutic use
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - Lung Neoplasms/complications
MH  - Male
MH  - Middle Aged
MH  - Neoplasms/*complications
MH  - Thrombosis/*drug therapy/etiology
MH  - Warfarin/therapeutic use
EDAT- 2005/11/16 09:00
MHDA- 2006/01/18 09:00
CRDT- 2005/11/16 09:00
PHST- 2005/11/16 09:00 [pubmed]
PHST- 2006/01/18 09:00 [medline]
PHST- 2005/11/16 09:00 [entrez]
AID - 62/22_Supplement_5/S7 [pii]
AID - 10.2146/ajhp050431 [doi]
PST - ppublish
SO  - Am J Health Syst Pharm. 2005 Nov 15;62(22 Suppl 5):S7-9. doi: 10.2146/ajhp050431.