What is the clinical evidence from this study?

Study design: Review. Population: Cancer-associated venous thrombosis. Intervention: Low-molecular-weight heparins (LMWHs) vs. Unfractionated heparin, oral anticoagulants, or placebo.

What does this research mean for the field?

Low-molecular-weight heparins have complex, product-specific effects in the treatment and prevention of cancer-associated venous thromboembolism, including potential non-antithrombotic effects on cancer progression, making a class effect unlikely. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 23, 2016Open Access

Heparins in cancer-associated venous thrombosis

ZKZbigniew KrasińskiPoznan University of Medical Sciences BKBeata KrasińskaPoznan University of Medical Sciences ŁDŁukasz DzieciuchowiczGrochowski Hospital

Key Result

Low-molecular-weight heparins are recommended as the standard of care for the prophylaxis and treatment of cancer-associated thrombosis, effectively reducing venous thromboembolism recurrence.

Structured PICO

Do heparins (particularly LMWHs) effectively and safely prevent and treat venous thromboembolism in patients with cancer?

Population

Patients with cancer at risk for or diagnosed with venous thromboembolism (VTE), including surgical, medical, and ambulatory patients.

Intervention

Heparins, particularly low-molecular-weight heparins (LMWHs)

Comparator

Unfractionated heparin (UFH), oral anticoagulants (e.g., warfarin), or placebo

Outcome

Incidence of venous thromboembolism (VTE), VTE recurrence, bleeding complications, and mortalityhard clinical

This review highlights that low-molecular-weight heparins are the preferred agents for both the prophylaxis and long-term treatment of cancer-associated venous thrombosis.

Limitations

The class effect of LMWHs on cancer treatment remains unclear.
Further research is needed to determine specific patient populations, tumor types, and therapies where LMWHs have the most favorable effects.

Abstract

A close causal relationship between cancer and venous thrombosis gives rise to questions about the effect of treatment modalities, in particular of the administered drugs, in patients with cancer-related venous thrombosis. An increased risk of chemotherapy-associated venous thromboembolism (VTE) has been well documented, while the effect of heparins used in VTE treatment on the disease course and prognosis in cancer patients has not been fully elucidated. This paper discusses the outcomes of the studies conducted so far investigating the role of heparins, in particular, low-molecular-weight heparins (LMWHs), in the prevention of thrombosis in cancer patients. It also focuses on such aspects of the treatment for cancer-associated VTE as treatment duration and drugs used. The paper summarizes the often discrepant results of long-term therapies with various LMWH products, emphasising that in this specific case the class effect is rather unlikely. It also presents the possible effects of heparins administered as part of cancer treatment, and points to the effects of LMWHs on cancer that are not related to an antithrombotic effect. On the 100th anniversary of heparin discovery, it can be said that heparin is irreversibly connected with thrombosis in the course of cancer.

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