Low molecular weight heparin (LMWH) usage for cancer patients under palliative care.

Abstract

1 Background: Cancer patients are at increased risk of thromboembolic complications. Studies show that prophylactic low molecular weight heparin (LMWH) can successfully reduce incidence of venous thromboembolic events; however, a survival benefit for patients with advanced cancer who receive LMWH in a palliative setting has not been confirmed. Methods: We evaluated the survival of cancer patients undergoing palliative treatment in a tertiary care hospital in Saudi Arabia during 2016. Patients were followed from the day of palliative care initiation until the day of death, and we compared the survival of patients who received LMWH (enoxaparin) with those who did not. Gender, diagnosis (site of cancer), and date of diagnosis were considered for subgroup analysis. Results: Of the 209 patients included in this study, enoxaparin was administered to 91(about 44%), while 117 (about 56%) did not receive any LMWH, and the treatment of one patient was not clearly defined. Male and female patients are equally distributed (104 and 105 patients, respectively). Cancer sites included breast, brain, gastrointestinal, genitourinary, lung, hematological malignancies, bone, and others. Although there was generally no statistical difference in survival time between treated and untreated groups (approximately 48 days each), subgroup analyses showed a statistically significant but not clinically significant survival benefit for patients with genitourinary cancers, such as uterine, urinary bladder, ovarian, or prostatic carcinomas who received LMWH (14.15 to 63.85 Days, P=0.0046). Conclusions: Prophylactic treatment with LMWH provided no clinically significant survival benefit to terminally ill cancer patients when administered in conjunction with other medications. Further prospective trials are warranted. Clinical trial information: ONC0329.