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Unique Identifier 97341944
Authors: Prandoni P.
Institution: Institute of Medical Semeiotics, University of Padova, Italy.
Title: Antithrombotic strategies in patients with cancer. [Review] [33 refs]
Source: Thrombosis & Haemostasis. 78(1):141-4, 1997 Jul.
Abstract: In recent years, a growing body of evidence has provided the convincing demonstration of a strong association between cancer and venous thromboembolism. Patients with cancer are at a remarkably higher risk of venous thromboembolism than patients free from malignant disorders during prolonged immobilization from any cause, and following surgical interventions. Standard heparin in adjusted doses or a low-molecular-weight heparin in doses commonly recommended for high risk surgical patients represent the prophylactic treatment of choice for cancer patients undergoing an extensive abdominal or pelvic intervention, Furthermore, the risk of thrombotic episodes is increased in cancer patients by chemotherapy and use of indwelling central venous catheters. Recent data suggest a positive benefit-to-risk ratio with the systematical use of fixed mini-dose of warfarin in both conditions. After experiencing an episode of thrombosis, cancer patients remain at risk of recurrence for as long as the cancer is active. Therefore, they should be protected by a long-term course of oral anticoagulation. The risk of recurrent thrombotic events despite adequate anticoagulation is markedly higher in patients with cancer than in those without cancer. The routine use of long-term subcutaneous heparin for patients in whom warfarin has been ineffective. Can antithrombotic drugs improve survival in cancer patients? In cancer patients affected by deep-vein thrombosis, the treatment with low-molecular-weight heparins has been reported to lower mortality at a higher extent than the standard heparin therapy. Such an observation suggests that these agents might develop an antineoplastic activity. [References: 33]

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Unique Identifier 90178897
Authors: Bern MM. Lokich JJ. Wallach SR. Bothe A Jr. Benotti PN. Arkin CF. Greco FA. Huberman M. Moore C.
Institution: New England Deaconess Hospital, Harvard Medical School, Boston, Massachusetts.
Title: Very low doses of warfarin can prevent thrombosis in central venous catheters. A randomized prospective trial.
Source: Annals of Internal Medicine. 112(6):423-8, 1990 Mar 15.
Abstract: OBJECTIVE: To determine whether very low doses of warfarin are useful in thrombosis prophylaxis in patients with central venous catheters. DESIGN: Patients at risk for thrombosis associated with chronic indwelling central venous catheters were prospectively and randomly assigned to receive or not to receive 1 mg of warfarin, beginning 3 days before catheter insertion and continuing for 90 days. Subclavian, innominate, and superior vena cava venograms were done at onset of thrombosis symptoms or after 90 days in the study. RESULTS: One hundred twenty-one patients entered the study, and 82 patients completed the study. Of 42 patients completing the study while receiving warfarin, 4 had venogram-proven thrombosis. All 4 had symptoms from thrombosis. Of 40 patients completing the study while not receiving warfarin, 15 had venogram-proven thrombosis, and 10 had symptoms from thrombosis (P less than 0.001). There were no measurable changes in the coagulation values assayed due to this warfarin dose, except in occasional patients who had become anorectic because of their disease or chemotherapy. CONCLUSIONS: Very low doses of warfarin can protect against thrombosis without inducing a hemorrhagic state. This approach may be applicable to other groups of patients.

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