Long-term use of daily subcutaneous low molecular weight heparin in cancer patients with venous thromboembolism: why hesitate any longer? |
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Authors: | Philippe Debourdeau Ismail Elalamy Axelle de Raignac Paul Meria Jean Marc Gornet Yahovi Amah Wolfang Korte Michel Marty Dominique Farge |
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Affiliation: | 1. Internal Medicine and Oncology Department, Desgenettes Military Hospital, 108 Bvd Pinel, 69275, Lyon cedex 3, France 2. Haemobiology Department, Assistance Publique H?pitaux de Paris, Tenon Hospital, 4 rue de la Chine, 75020, Paris, France 3. Department of Internal Medicine and Vascular Pathology, and INSERM U 697, Assistance Publique H?pitaux de Paris, Saint-Louis Hospital, 1 avenue Claude-Vellefaux, 75010, Paris, France 4. Department of Urology, Assistance Publique H?pitaux de Paris, Saint-Louis Hospital, 1 avenue Claude-Vellefaux, 75010, Paris, France 5. Department of Gatroenterology, Assistance Publique H?pitaux de Paris, Saint-Louis Hospital, 1 avenue Claude-Vellefaux, 75010, Paris, France 6. Internal Médicine Department, University Hospital, Lomé, Togo 7. Institute for Clinical Chemistry and Hematology, Kantonsspital, 9007, St. Gallen, Switzerland 8. University of Bern, Bern, Switzerland 9. Assistance Publique H?pitaux de Paris, Saint-Louis Hospital, Service de Greffe de Moelle, 1 avenue Claude-Vellefaux, 75010, Paris, France 10. INSERM U 697 Paris, France Saint-Louis Hospital, 1 avenue Claude-Vellefaux, 75010, Paris, France 11. Service de Médecine Interne et Pathologie Vasculaire, H?pital Saint-Louis, INSERM U697, 1 avenue Claude-Vellefaux, 75010, Paris, France
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Abstract: | Introduction Cancer disease inducing an acquired hypercoagulable state is a well-established feature. Venous thromboembolism (VTE) occurs in 4% to 20% of the patients and is the second cause of mortality in cancer; VTE incidence is four to six times higher in cancer patients compared to other patients. In the last 10 years, important randomised clinical trials have clearly demonstrated that long-term use of daily subcutaneous low molecular weight heparin (LMWH) is more efficient than Vitamin K antagonists to treat VTE in cancer patients. First Italian, then American and more recently French national guidelines recommend the use of LMWH for 3 to 6 months for curative treatment of VTE in cancer patients with a clearly high level (A) of evidence. Despite convincing data, many physicians have not yet modified their clinical practice, doubting the tolerability of such a long period of subcutaneous injections. In fact, LMWH long-term use appears well tolerated and may also increase cancer patient survival. Objectives The aim of this review is to present the scientific rationale for long-term daily subcutaneous LMWH in cancer patients, and to reinforce the favourable benefit/tolerance tolerability ratio with this specific antithrombotic strategy. |
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Keywords: | Low molecular weight heparins Venous thromboembolism Cancer Quality of life Survival |
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