Low Molecular Weight Heparin in Patients with Cancer: A New Option

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4058-4058
Author(s):  
Giorgio Corinaldesi ◽  
Christian Corinaldesi
Keyword(s):  
Molecular Weight ◽  
Cancer Biology ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Minor Bleeding ◽  
Vein Thrombosis ◽  
Patients With Cancer ◽  
Cancer Breast ◽  
Metastatic Activity ◽  
Deep Vein

Abstract The use of heparin for venous thromboembolism, upper extremity deep vein thrombosis (DVT), septic thrombophlebitis, loss of central venous device access in patients with cancer is a standard practice; a new clinical evidence suggest that low molecular weight heparin (LMWHs) may prolong survival in patients with cancer and may have anti-neoplastic effects and anti-metastatic activity. We evaluated 74 patients with cancer (38 patients were allocated to enoxaparin 6000UI subcutaneously once a day, and 36 patients were allocated to placebo), the mean duration of follow-up was 12 months, platelet count were performed before the treatment, and once a month; in the event of thrombocytopenia < 50.000/ml or abnormal bleeding the treatment was stopped. The primary end points were overall survival, and metastasis progression. TAB:A Enoxaparin (n.38) Placebo (n.36) Age-years (range) 46–68 48–66 Sex (male/female) 20/18 20/16 Metastasis disease     a) before 10 12     b) end-therapy 12 18 Type of cancer     Breast cancer 8 8     Endometrial cancer 6 5     Gastric or esophageal 4/2 3/1     Colorectal cancer 6/2 8/2     Prostatic cancer 6 7     Urothelial 2 1     Lung 2 1 Death 3 8     Major bleeding 1 0     Minor bleeding 4 4     Allergic reaction 0 0     VTE 6 0 Concomitant anti-neoplastic therapy     Chemotherapy 26 26     Radiotherapy 2 1     Combined 4 3         Hormonal 6 6 These data show that LMWHs reduce or attenuate metastasis at 12 month by 11.4%, and death by 8.8%, with a significant increase of median survival. Heparin have show to have direct antigrowth, antiangiogenesis, and antimetastatic effects, LMWHs minimize angiogenesis with the inhibition of VEGF and b-FGF, inhibit the adhesion of cancer cells to endothelium and the interaction mediated by tumor cells surface mucins and selectin, and they interfere with cancer biology; we can speculate that the binding of tumor growth to heparin have a crucial role in the modulation of activity of the high affinity receptors, it promotes receptors dimerization and activation, inhibits P and L-selectins and chemokine action (IL-8, Mip-1), blocks MMP, serin-protease and heparanase, decreases over-expression of TF and PAF, induces and increases apoptosis.

scholarly journals Anti-Xa monitoring of low-molecular-weight heparin in adult patients with cancer

Hematology ◽  
2016 ◽  
Vol 2016 (1) ◽  
pp. 206-207 ◽  
Author(s):  
Lisa Baumann Kreuziger ◽  
Michael Streiff
Keyword(s):  
Prostate Cancer ◽  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Low Molecular Weight Heparin ◽  
Femoral Vein ◽  
Stage Iv ◽  
Low Molecular Weight ◽  
Vein Thrombosis ◽  
Patients With Cancer ◽  
Deep Vein

Abstract A 68-year-old man developed a right femoral vein deep vein thrombosis and bilateral pulmonary embolism while receiving chemotherapy for stage IV prostate cancer. His creatinine at diagnosis is 1.4 mg/dL, with an estimated clearance of 63 mL/min. In patients with cancer, should low-molecular-weight heparin treatment be dosed according to weight, or adjusted using anti-Xa levels?

Postoperative Versus Preoperative Initiation of Deep-Vein Thrombosis Prophylaxis with a Low-Molecular-Weight Heparin (Nadroparin) in Elective Hip Replacement

1996 ◽  
Vol 2 (1) ◽  
pp. 18-24 ◽  
Author(s):  
Gualtiero Palareti ◽  
Battista Borghi ◽  
Sergio Coccheri ◽  
Nicoletta Leali ◽  
Rita Golfieri ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Deep Vein Thrombosis ◽  
Hip Replacement ◽  
Low Molecular Weight Heparin ◽  
Bleeding Complications ◽  
Thrombosis Prophylaxis ◽  
Low Molecular Weight ◽  
Minor Bleeding ◽  
Vein Thrombosis ◽  
Deep Vein

The aim of this multicenter, randomized, dou ble-blind study performed in patients undergoing elective hip surgery was to compare the efficacy and safety of prophylaxis with low-molecular-weight heparin (LMWH) (Nadroparin, 7,500 anti-Xa IC units for the first 3 days and 10,000 from the fourth day on, s.c. o.i.d.) begun in one group shortly after surgery and in the other 12 h before operation, as is usually recommended. Preopera tive administration (drug or placebo) was the only differ ence between the two groups. Deep vein thrombosis (DVT) was detected by bilateral venography 10-15 days after surgery. The study investigated 179 patients (55 men), 40-80 years old, in seven Italian orthopedic cen ters. In 131 patients efficacy analysis was possible be cause of adequate bilateral venography. All 179 patients were evaluated for bleeding complications. The preva lence of thrombotic complications was similar in the two groups. Proximal DVT was found in 8.4% of patients (10.8% and 6.1% in the preop and postop groups, respec tively ; difference not statistically significant). Distal DVT was recorded in 30.5% of patients (30.8% and 30.3% in the pre- and postop groups, respectively). DVTs were more common in patients ≥65 years old (54.2% versus 28.4%, p < 0.05); no significant differences were detected in terms of other characteristics. No significant differ ences were recorded in the number or type of bleeding complications: major (nonfatal) bleeding episodes were reported in five patients (2.8%, two and three in the pre- and postop groups); minor bleeding was noted in 25 (13.9%, 14 and 11 in the pre- and postop groups). In con clusion, the present study suggests that a LMWH regi men started postoperatively is no less effective in pre venting DVT in elective hip replacement than the classi cal regimen started preoperatively. Surprisingly, postoperative commencement offered no significant ad vantage in terms of bleeding complications.

scholarly journals Optimal Duration of Low Molecular Weight Heparin for the Treatment of Cancer-Related Deep Vein Thrombosis: The Cancer-DACUS Study

2014 ◽  
Vol 32 (32) ◽  
pp. 3607-3612 ◽  
Author(s):  
Mariasanta Napolitano ◽  
Giorgia Saccullo ◽  
Alessandra Malato ◽  
Delia Sprini ◽  
Walter Ageno ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Deep Vein Thrombosis ◽  
Major Bleeding ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Vein Thrombosis ◽  
Patients With Cancer ◽  
Optimal Duration ◽  
Group B ◽  
Deep Vein

Purpose We evaluated the role of residual vein thrombosis (RVT) to assess the optimal duration of anticoagulants in patients with cancer who have deep vein thrombosis (DVT) of the lower limbs. Patients and Methods Patients with active cancer and a first episode of DVT treated with low molecular weight heparin (LMWH) for 6 months were eligible. Patients were managed according to RVT findings: those with RVT were randomly assigned to continue LMWH for an additional 6 months (group A1) or to discontinue it (group A2), and patients without RVT stopped LMWH (group B). The primary end point was recurrent venous thromboembolism (VTE) during the 1 year after disconinuation of LMWH, and the secondary end point was major bleeding. Analyses are from the time of random assignment. Results Between October 2005 and April 2010, 347 patients were enrolled. RVT was detected in 242 patients (69.7%); recurrence occurred in 22 of the 119 patients in group A1compared with 27 of 123 patients in group A2. The adjusted hazard ratio (HR) for group A2 versus A1 was 1.37 (95% CI, 0.7 to 2.5; P = .311). Three of the 105 patients in group B developed recurrent VTE; adjusted HR for group A1 versus B was 6.0 (95% CI, 1.7 to 21.2; P = .005). Three major bleeding events occurred in group A1, and two events each occurred in groups A2 and B. The HR for major bleeding in group A1 versus group A2 was 3.78 (95% CI, 0.77 to 18.58; P = .102). Overall, 42 patients (12.1%) died during follow-up as a result of cancer progression. Conclusion In patients with cancer with a first DVT, treated for 6 months with LMWH, absence of RVT identifies a population at low risk for recurrent thrombotic events. Continuation of LMWH in patients with RVT up to 1 year did not reduce recurrent VTE.

Comparison of a once Daily with a twice Daily Subcutaneous Low Molecular Weight Heparin Regimen in the Treatment of Deep Vein Thrombosis

1998 ◽  
Vol 79 (05) ◽  
pp. 897-901 ◽  
Author(s):  
Bernard A. Charbonnier ◽  
Jean-Noël Fiessinger ◽  
J. D. Banga ◽  
Ernst Wenzel ◽  
Pascal d’Azemar ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Daily Regimen ◽  
Once Daily ◽  
Daily Group ◽  
Vein Thrombosis ◽  
Deep Vein

SummaryBackground: Clinical trials have been performed to compare with standard heparin a once or a twice daily regimen of low-molecular-weight heparin but no direct comparison has been done between these two low-molecular-weight heparin regimens in terms of efficacy and safety with a long-term clinical evaluation.Methods: Patients with proximal deep vein thrombosis, confirmed by venography were randomly assigned to either nadroparin (10,250 AXa IU/ml) twice daily or nadroparin (20,500 AXa IU/ml) once daily for at least 5 days. Regimens were adjusted to bodyweight. Oral anticoagulants were started on day 1 or 2 and continued for 3 months. Patients were followed up for 3 months. The composite outcome of venous thromboembolism and death possibly related to pulmonary embolism was the primary measure of efficacy. Major bleeding was the principal measure of safety. The study was designed to show equivalence between the two regimens.Results: Recurrent thromboembolic events or death possibly related to pulmonary embolism were reported in 13 patients in the once daily group (4.1%) and in 24 patients of the twice daily group (7.2%): (absolute difference 3.1% in favor of the once daily regimen; 95% confidence interval -6.6%, +0.5%). Major bleeding episodes during nadroparin treatment occurred in 4 (1.3%) and 4 patients (1.2%) in the once and twice daily groups, respectively.Conclusions: A nadroparin regimen of one injection per day is at least as effective and safe as the same total daily dose divided over two injections for the treatment of acute deep vein thrombosis.

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