Current Perspectives on Primary Prophylaxis and Patient Risk Factors for Venous Thromboembolism in the Cancer Patient

Cancer Control 11VTE in the cancer setting, hematologists and oncologists are beginning to examine this complication more closely.Because of the strong relationship between thrombosis and cancer, a number of pressing questions need to be addressed.Critical issues include deciding what role anticoagulants should play in the primary prevention of VTE in cancer patients and determining when the use of these agents is appropriate.To consider these issues, this review examines available epidemiological and clinical evidence, experience with low-molecular-weight heparins (LMWHs) and other anticoagulant options, appropriate evidencebased recommendations for anticoagulant therapy, and areas for further consideration due to the potential for increased risk that may require greater vigilance. VTE in the Cancer SettingThe epidemiological literature has observed a strong association between VTE and cancer.The Olmsted County analysis by Silverstein et al 6 from the Mayo Clinic has provided some of the most notable observations.This 25-year retrospective epidemiological study examined the medical records of 2,218 patients living in Olmsted County, Minnesota.The investigators found an annual incidence of thrombosis of approximately 1 in 1,000 in the overall pop- Current Perspectives on Primary Prophylaxis and Patient Risk Factors for Venous Thromboembolism in the Cancer PatientHoward A. Liebman, MD The high prevalence of venous thromboembolism in cancer patients and the factors that increase the risk for this complication deserve emphasis.