Impact of Low Molecular Weight Heparin on Overall Survival in Patients with Advanced Lung Cancer: A Retrospective Study

Rammey Hassan

doi:10.11648/j.ajcem.20170505.13

Abstract

Low Molecular Weight Heparin (LMWH) is approved for treatment of and secondary prophylaxis against thromboembolic events in patients with cancer. However, its role in improving Overall Survival (OS) remains unclear. A retrospective study to evaluate effect of LMWH on OS in advanced lung cancer was conducted by retrospectively identifying patients with advanced lung cancer (stage IIIA, IIIB and IV) including non-small cell, small cell and rare histopathologic subtypes from 2004 to 2014. Patients with early stage lung cancer and those with incomplete information were excluded. Data on patient demographics (age, gender, ethnicity), histopathology, staging, medications (including chemotherapy and anticoagulants) and patient outcome were collected. Death was considered as the final endpoint. Patients with and without LMWH use were identified. This study did not find an improvement in OS with use of LMWH in advanced stage lung cancer patients. Even though the results were not statistically significant, there was a trend towards higher mortality in patients treated with LMWH for thrombosis compared to patients without thrombosis. Future prospective studies using a larger patient population should evaluate the impact of prophylactic versus therapeutic LMWH on OS in advanced lung cancer.

Highlights

Lung cancer is the leading cause of cancer deaths among both males and females in America [1]
Most of the reviewed literature aimed to determine the benefit of low molecular weight heparin (LMWH) on overall survival in patients with advanced malignancy
This study is unique in that it sought out to determine if LMWH had a benefit to Overall Survival (OS) for patients with advanced lung malignancy with thrombosis compared to without thrombosis

Summary

Introduction

Lung cancer is the leading cause of cancer deaths among both males and females in America [1]. Venous thromboembolism (VTE) is common in lung cancer patients and may be precipitated by venous stasis, activation of clotting cascades by pro-coagulant tumor factors, and by vascular injury due to chemotherapy and central venous catheters [3]. Despite advances in the understanding of malignancy and thromboembolic events, there are still limitations in clinical management being that patients (cancer and non-cancer) still die from vascular thromboembolic events even when diagnosed and appropriately managed [4]. Venous thromboembolism (VTE) incidence is around 40-100 cases per 1000 person-years in lung carcinoma patients in contrast to 1-2 cases per 1000 person-years in the general population [5].

Results

Discussion

Conclusion