Thromboprophylaxis during chemotherapy in patients with advanced cancer

Abstract

Venous thromboembolism is a common and potentially fatal complication in patients with advanced cancer. In these patients chemotherapy has been identified as an independent risk factor for venous thromboembolism. The annual incidence of venous thromboembolism in cancer patients who receive chemotherapy is estimated to be about 10%. This risk increases up to 15–20% depending on type and combination of anticancer agents. The occurrence of venous thromboembolic events in cancer patients is associated with a poor prognosis. The benefit of antithrombotic prophylaxis for venous thromboembolism in cancer patients who receive chemotherapy has been recently evaluated in a randomized, placebo-controlled, double-blind trial (the PROTECHT study). The aim of this study was to evaluate the efficacy and safety of the low molecular weight heparin nadroparin in the prevention of venous and arterial thromboembolic events during chemotherapy. The results of the PROTECHT study demonstrated that nadroparin reduces by 50% the rate of thromboembolic events in ambulatory patients with metastatic or locally advanced cancer while they receiving chemotherapy. The antithrombotic effect was more evident in patients with lung and gastrointestinal cancer. In future studies the clinical benefit of antithrombotic prophylaxis should be evaluated in cancer patients at particularly high risk for thromboembolism.