Clinicians must always maintain a heightened suspicion for the development of venous thromboembolism (VTE) in the cancer patient population. VTE is common in this population and often results in morbidity and mortality. The pathophysiology is complex and likely multifactorial. Risk factors for VTE include patient-associated, cancer-associated, and treatment-associated factors as well as biomarkers. Low-molecular-weight heparin (LMWH) is a cornerstone for VTE prophylaxis and treatment. Studies have shown that LMWH may decrease VTE recurrence and impart a survival benefit. Organizational guidelines are available to assist the clinician in choosing appropriate anticoagulant agents, dosing, and duration of prophylaxis and treatment. Pharmacists serve an important role for the safe and effective management of anticoagulation in this complex patient population. In addition, pharmacists can be important providers of patient education about VTE and anticoagulation.
HeitJAO’FallonWMPettersonTM. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism. A population-based study. Arch Intern Med. 2002;162(11):1245–1248.
2.
PrandoniP. How I treat venous thromboembolism in patients with cancer. Blood. 2005;106(13):4027–4033.
3.
LeeA. VTE in patients with cancer—diagnosis, prevention, and treatment. Thromb Res. 2008;123(Suppl 1):S50–S54.
4.
BlomJWDoggenCJOsantoS. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA. 2005;293(6):715–722.
5.
WhiteRHChewHKZhouH. Incidence of venous thromboembolism in the year before the diagnosis of cancer in 528,693 adults. Arch Intern Med. 2005;165(15):1782–1787.
6.
LeeAYLevineMN. Venous thromboembolism and cancer: risks and outcomes. Circulation. 2003;107(23 Suppl 1):I17–I21.
7.
EltingLSEscalanteCPCooksleyC. Outcomes and cost of deep venous thrombosis among patients with cancer. Arch Intern Med. 2004;164(15):1653–1661.
8.
AmbrusJLAmbrusCMMinkIB. Causes of death in cancer patients. J Med. 1975;6(1):61–64.
9.
ShenVSPollakEW. Fatal pulmonary embolism in cancer patients: is heparin prophylaxis justified?South Med J. 1980;73(7):841–843.
10.
SorensenHTMellemkjaerLOlsenJH. Prognosis of cancers associated with venous thromboembolism. N Engl J Med. 2000;343(25):1846–1850.
11.
National Comprehensive Cancer Network. Venous Thromboembolic Disease. NCCNClinical Practice Guidelines in Oncology. V.1;2009.
12.
MenziesKEMackmanNTaubmanMB. Role of tissue factor in cancer. Cancer Invest. 2009;27(S1):53–62.
13.
AharonABrennerB. Microparticles, thrombosis and cancer. Best Prac Res Clin Haematol. 2009;22(1):61–69.
ConnollyGCKhoranaAA. Risk stratification for cancer-associated venous thromboembolism. Best Prac Res Clin Haematol. 2009;22(1):35–47.
16.
WunTWhiteRH. Venous thromboembolism (VTE) in patients with cancer: epidemiology and risk factors. Cancer Invest. 2009;27(Suppl 1):63–74.
17.
SousouTKhoranaAA. New insights into cancer-associated thrombosis. Arterioscler Thromb Vasc Biol. 2009;29(3):316–320.
18.
LymanGHKhoranaAAFalangaA. American Society of Clinical Oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer. J Clin Oncol. 2007;25(34):5490–5505.
19.
KhoranaAAKudererNMCulakovaE. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood. 2008;111(10):4902–4907.
20.
GeertsWHBergqvistDPineoGF. Prevention of venous thromboembolism. American College of Chest Physicians evidence-based clinical practice guidelines (8th ed). Chest. 2008;133(6 Suppl):381S–453S.
21.
KearonCKahnSRAgnelliG. Antithrombotic therapy for venous thromboembolic disease. American College of Chest Physicians evidence-based clinical practice guidelines (8th ed). Chest. 2008;133(6 Suppl):454S–545S.
22.
AminAStemkowskiSLinJ. Appropriate thromboprophylaxis in hospitalized cancer patients. Clin Adv Hematol Oncol. 2008;6(12):911–920.
23.
KakkarAKLevineMPinedoHM. Venous thrombosis in cancer patients: insights from the FRONTLINE survey. Oncologist. 2003;8(4):381–388.
24.
AgnelliGBolisGCapussottiL. A clinical outcome-based prospective study on venous thromboembolism after cancer surgery. The @RISTOS project. Ann Surg. 2006;243(1):89–95.
25.
NilssonKRBerenholtzSMGarrett-MayerE. Association between venous thromboembolism and perioperative allogeneic transfusion. Arch Surg. 2007;142(2):126–132.
26.
RasmussenMSJorgensenLNWille-JorgensenP. Prolonged prophylaxis with dalteparin to prevent late thromboembolic complications in patients undergoing major abdominal surgery: a multicenter randomized open-label study. J Thromb Haemost. 2006;4(11):2384–2390.
27.
BergqvistDAgnelliGCohenAT. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med. 2002;346(13):975–980.
28.
AgnelliGGussoniGBianchiniC. A randomized double-blind placebo-controlled study on nadroparin for prophylaxis of thromboembolic events in cancer patients receiving chemotherapy: the PROTECHT study. Blood (ASH annual meeting abstracts) 2008;112: Abstract 6.
29.
EliceFRodeghieroFFalangaA. Thrombosis associated with angiogenesis inhibitors. Best Prac Res Clin Haematol. 2009;22(1):115–128.
30.
NalluriSRChuDKeresztesR. Risk of venous thromboembolism with the angiogenesis inhibitor bevacizumab in cancer patients: a meta-analysis. JAMA. 2008;300(19):2277–2285.
31.
BennettCLSilverSMDjulbegovicB. Venous thromboembolism and mortality associated with recombinant erythropoietin and darbepoetin administration for the treatment of cancer-associated anemia. JAMA. 2008;299(8):914–924.
RizzoJDSomerfieldMRHagertyKL. Use of epoetin and darbepoetin in patients with cancer: 2007 American Society of Hematology/American Society of Clinical Oncology clinical practice guideline update. Blood. 2008;111:25–41.
35.
Food and Drug Administration. Available at:www.fda.gov. Accessed April 17, 2010.
National Comprehensive Cancer Network. Cancer-and chemotherapy-induced anemia. NCCN Practice Guidelines in Oncology. v.1; 2009.
38.
LeeAY. Treatment of venous thromboembolism in cancer patients. Best Prac Res Clin Haematol. 2009;22(1):93–101.
39.
AklEARohillaSBarbaM. Anticoagulation for the initial treatment of venous thromboembolism in patients with cancer. A systematic review. Cancer. 2008;113(7):1685–1694.
40.
MeyerGMarjanovicZValckeJ. Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study. Arch Intern Med. 2002;162(15):1729–1735.
41.
LeeAYLevineMNBakerRI. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med. 2003;349(2):146–153.
42.
AklEABarbaMRohillaS. Low-molecular-weight heparins are superior to vitamin K antagonists for the long term treatment of venous thromboembolism in patients with cancer: a cochrane systematic review. J Exper Clin Cancer Res. 2008;27:21.
43.
DeitcherSRKesslerCMMerliG. Secondary prevention of venous thromboembolic events in patients with active cancer: enoxaparin alone versus initial enoxaparin followed by warfarin for a 180-day period. Clin Appl Thromb Hemost. 2006;12(4):389–396.
44.
HullRDPineoGFMahAF. A randomized trial evaluating long-term low-molecular-weight heparin therapy for three months versus intravenous heparin followed by warfarin sodium [abstract]. Blood. 2002;100(11):148a.
45.
HullRDPineoGFBrantRF. Long-term low-molecular-weight heparin versus usual care in proximal-vein thrombosis patients with cancer. Am J Med. 2006;119(12):1062–1072.
46.
KakkarAKLevineMNKadziolaZ. Low molecular weight heparin, therapy with dalteparin, and survival in advanced cancer: the Fragmin Advanced Malignancy Outcome Study (FAMOUS). J Clin Oncol. 2004;22(10):1944–1948.
47.
LeeAYRicklesFRJulianJA. Randomized comparison of low molecular weight heparin and coumarin derivatives on the survival of patients with cancer and venous thromboembolism. J Clin Oncol. 2005;23(10):2123–2129.
48.
LemoineNR. Antithrombotic therapy in cancer. J Clin Oncol. 2005;23(10):2119–2120.
49.
PangilinanJMPangilinanPHWordenFP. Use of warfarin in the patient with cancer. J Support Oncol. 2007;5(3):131–136.
50.
PrandoniPLensingAWPiccioliA. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood. 2002;100(10):3484–3488.
51.
HuttenBAPrinsMHGentM. Incidence of recurrent thromboembolic and bleeding complications among patients with venous thromboembolism in relation to both malignancy and achieved international normalized ratio: a retrospective analysis. J Clin Oncol. 2000;18(17):3078–3083.
52.
Trujillo-SantosJRuiz-GamieteaALuqueJM. Predicting recurrences or major bleeding in women with cancer and venous thromboembolism. Findings from the RIETE registry. Thromb Res. 2009;123(Suppl 2):S10–S15.
53.
BonaRDSivjeeKYHickeyAD. The efficacy and safety of oral anticoagulation in patients with cancer. Thromb Haemost. 1995;74(4):1055–1058.
54.
AnsellJHirshJHylekE. Pharmacology and management of the vitamin K antagonists. American College of Chest Physicians evidence-based clinical practice guidelines (8th ed). Chest. 2008;133(6 Suppl):160S–198S.
