Management of venous thromboembolism in cancer patients

Venous thromboembolism (VTE) in cancer patients is a common and severe clinical problem. The incidence of VTE has been rising as the number of cancer patients increases. Because the pathophysiology of thrombosis is multifactorial, there is no ‘one fits all’ prophylaxis or treatment. Thromboprophylaxis with a low molecular weight heparin (LMWH) is recommended for hospitalized cancer patients unless contraindicated. However, thromboprophylaxis is not customarily advised for ambulatory cancer patients. Patients developing a VTE are usually treated with a LMWH, and this agent is continued long-term rather than switched to a vitamin K antagonist. The new oral anticoagulants are currently not recommended for cancer patients until further experience with these drugs suggests otherwise. An increasing population of elderly patients, limited health care resources, and financial constraints will affect treatment options in the future. Prevention and treatment of VTE will be optimized when oncologists and patients become aware and fully informed about this disorder.