Thromboprophylaxis in Pancreatic Cancer: Why isn’t Prime Time Here Compared to Multiple Myeloma?

Abstract

Hypercoagulability and the clinical manifestation of VTE are shared by most cancers and the use of chemotherapy canfurther increase this risk. VTE in cancer patients results in increased morbidity and mortality [1]. Patients with advanced pancreatic cancer (APC) have one of the worst prognoses of all malignancies and the highest incidence of disease provoked venous thromboembolism (VTE) [2]. Given the prominence of VTE in APC, it is not surprising that data on VTE prevention for APC have been generated from subgroup analysis of non-APC targeted placebo-controlled randomized trials of cancer patients treated with chemotherapy. Further data is derived from trials dedicated to evaluate VTE prophylaxis in APC patients. These studies have been rather homogeneous in that only low molecular weight heparins (LMWH) have been investigated for anticoagulation. The choice of LMWH was partly industry driven (e.g. study of new agent such as the semi-synthetic LMWH semuloparin) and partly due to the established superiority of LMWH over vitamin K analogues in terms of safety and efficacy both in VTE prophylaxis when given in nononcologic settings and in the therapeutic (treatment) settings of malignancy associated established VTE [3].