Hamostaseologie 2019; 39(01): 067-075
DOI: 10.1055/s-0039-1677796
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Low-Molecular-Weight Heparin in Cancer Patients: Overview and Indications

Minna Voigtlaender
1   II. Medizinische Klinik und Poliklinik, Hubertus Wald Tumorzentrum – Universitäres Cancer Center Hamburg (UCCH), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
,
Florian Langer
1   II. Medizinische Klinik und Poliklinik, Hubertus Wald Tumorzentrum – Universitäres Cancer Center Hamburg (UCCH), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
› Author Affiliations
Further Information

Publication History

13 September 2018

03 January 2019

Publication Date:
31 January 2019 (online)

Abstract

Although venous thromboembolism (VTE) is a well-known cause of death in patients with cancer, both its treatment and prevention remain a challenge in daily practice. Direct oral anticoagulants have emerged as safe and efficacious alternatives to vitamin K antagonists in the general population, and recent clinical trials also support their use in select patients with cancer-associated VTE. Despite this, low-molecular-weight heparins (LMWHs), a comparatively ancient class of antithrombotic drugs, remain the anticoagulants of choice in many indications relevant to modern haematology and oncology. In addition to the treatment of established VTE, these indications include VTE prophylaxis in surgical or acutely ill, hospitalized medical cancer patients as well as the prevention of VTE in high-risk patients undergoing ambulatory chemotherapy. In a constantly changing landscape of approved anticancer agents, this review article summarizes pivotal clinical trial data and guideline recommendations regarding the use of LMWH in haematological and oncological patients, who constitute a highly vulnerable patient population due to their increased risk for both bleeding and VTE recurrence.

Zusammenfassung

Obwohl die venöse Thromboembolie (VTE) bekanntermaßen zur Mortalität von Krebspatienten beiträgt, stellen ihre Therapie und Prophylaxe unverändert eine große Herausforderung dar. Direkte orale Antikoagulantien (DOAKs) haben sich bei nichtonkologischen Patienten als sichere und wirksame Alternativen zu den Vitamin K-Antagonisten etabliert. Zudem legen kürzlich publizierte Studien den Einsatz von DOAKs bei ausgewählten Krebspatienten mit VTE nahe. Nichtsdestotrotz bleiben niedermolekulare Heparine (NMHs), eine vergleichsweise alte Substanzklasse, die Antikoagulantien der Wahl in einer Reihe von Indikationen, die auch in der modernen Hämatologie und Onkologie von hoher Relevanz sind. Hierzu zählt neben der VTE-Therapie die VTE-Prophylaxe bei chirurgischen oder akut kranken, hospitalisierten internistischen sowie bei ambulanten Tumorpatienten mit hohem VTE-Risiko. In einer sich ständig wandelnden Landschaft von zugelassenen Krebstherapeutika fasst diese Übersichtsarbeit wichtige Studiendaten und Leitlinienempfehlungen bezüglich des Einsatzes von NMH bei Tumorpatienten zusammen, die aufgrund ihres hohen Blutungs- und VTE-Rezidivrisikos ein besonders vulnerables Kollektiv darstellen.

 
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