Originally published as JCO Early Release 10.1200/JCO.2009.22.3958 on September 8 2009

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Anticoagulation in the Treatment of Established Venous Thromboembolism in Patients With Cancer

From the Thrombosis Program, University of British Columbia and Vancouver Coastal Health; Department of Medicine, University of British Columbia, Vancouver, British Columbia; and Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

Corresponding author: Agnes Y.Y. Lee, MD, Diamond Health Care Centre, 2775 Laurel St, 10th Fl, Vancouver, British Columbia, V5Z 1M9, Canada; e-mail: alee14{at}bccancer.bc.ca.

Cancer-associated thrombosis is a frequent and costly complication in patients with cancer. Significant morbidity and mortality not only result from thrombotic events, but may also occur as a result of the therapeutic interventions. The established treatment for cancer-associated thrombosis is anticoagulant therapy. Of the few options available, low molecular weight heparin (LMWH) is the preferred agent because of its efficacy, safety, and convenience. Alternatives to LMWH have undesirable limitations and have demonstrated poorer efficacy and safety in the oncology population. Treatment of recurrent thrombosis, patients with concurrent bleeding issues, role of vena cava filter insertion, and duration of therapy are all areas in need of urgent research. Treatment of cancer-associated thrombosis remains a challenging task and is limited by the paucity of evidence-based data. Research is urgently needed to advance current practice and improve patient care.

Author's disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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