Cancer and venous thromboembolism: prevention, treatment and survival

Venous thromboembolism (VTE) occurs frequently in patients with cancer. It can be difficult to manage, sometimes delay cancer therapy and predicts for a worse prognosis. Hence, effective methods to prevent and treat VTE can reduce morbidity and mortality. Prophylaxis with anticoagulants is recommended for patients hospitalized for surgery or medical conditions, but is not routinely administered in the ambulatory setting. Traditional anticoagulation with a heparin followed by vitamin K antagonist therapy for cancer patients with acute VTE is associated with a high frequency of treatment failure and bleeding complications. Low molecular weight heparins (LMWHs) have simplified and improved the management of VTE, and recent studies suggest these agents may improve survival in patients with limited or early stage disease. This brief review will provide an update on the primary prevention and treatment of VTE and discuss the evidence for the survival advantage associated with LMWH use in patients with malignancy.