The increased risk of thrombosis associated with cancer has been known since Trousseau's
observations in the 19th century. Roughly 15 to 20 years ago, studies found that patients with cancer and
thrombosis had a higher likelihood of recurrent thrombosis despite the use of anticoagulation,
and an increased risk of bleeding with anticoagulation, than patients without cancer
[
[1]
]. At that time, cancer treatments were limited to combinations of surgery and radiation,
and conventional chemotherapy with regimens comprised of chemical agents that impaired
cell replication in an indiscriminate manner. Anticoagulation options were also limited,
either to low molecular weight heparin (LMWH) given by injection only, or to warfarin,
an oral medication but difficult to manage due to drug-drug and drug-food interactions,
especially in the setting of conventional chemotherapy. Trials of warfarin vs LMWH
revealed that LMWH had better efficacy at preventing recurrent venous thrombosis,
although bleeding rates were similar with both, as demonstrated in the largest such
randomized controlled trial (RCT), the CLOT trial [
[2]
].- Lee A.Y.
- Levine M.N.
- Baker R.I.
- Bowden C.
- Kakkar A.K.
- Prins M.
- Rickles F.R.
- Julian J.A.
- Haley S.
- Kovacs M.J.
- Gent M.
Randomized comparison of low-molecular-weight heparin versus oral anticoagulant therapy
for the prevention of recurrent venous thromboembolism in patients with cancer (CLOT)
investigators.Lee AY, et al.
N Engl J Med. 2003; 349 (Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous
thromboembolism in patients with cancer): 146-153https://doi.org/10.1056/NEJMoa025313
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References
- Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis.Blood. 2002; 100: 3484-3488
- Randomized comparison of low-molecular-weight heparin versus oral anticoagulant therapy for the prevention of recurrent venous thromboembolism in patients with cancer (CLOT) investigators.Lee AY, et al.N Engl J Med. 2003; 349 (Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer): 146-153https://doi.org/10.1056/NEJMoa025313
- Incidence, predictors and prognostic significance of thromboembolic disease inpatients with advanced ALK-rearranged non-small cell lung cancer.Eur Respir J. 2018; 511702431
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- Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D).J Clin Oncol. 2018; 36: 2017-2023
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Alberto Carmona-Bayonas, et al., A snapshot of cancer-associated thromboembolic disease in 2018-2019: first data from the TESEO prospective registry. Eur J Int Med. doi.org/10.1016/j.ejim.2020.05.031.
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Article info
Publication history
Published online: June 16, 2020
Accepted:
June 10,
2020
Received:
June 7,
2020
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
