Routine Heparin for Patients with Cancer? One Answer, More Questions

The antithrombotic effect of heparins is established, and it is speculated that a direct antitumor effect of heparin might translate into a survival benefit in patients with cancer. This antitumor activity of heparins mechanistically includes the inhibition of cell–cell interaction by blocking cell-adhesion molecules (selectins), the inhibition of extracellular-matrix protease heparanase, and the inhibition of angiogenesis.1 Should heparin, thus, be offered to patients with cancer who have no standard indication for anticoagulation therapy?A large, randomized clinical trial addressing this question is reported by Agnelli and colleagues in this issue of the Journal.2 The SAVE-ONCO study (ClinicalTrials.gov number, NCT00694382) . . .