MNT - article - Heparin - Possible Cancer Treatment

Low Molecular Weight Heparin Use in Cancer Treatment

Low Molecular Weight Heparin Use in Cancer Treatment

The blood thinning effect of heparin is well established, but should it be used in cancer treatment?

Newswise — Hamilton, ON (Feb. 13, 2012) -
"For decades, the blood thinner heparin has been used to prevent and treat blood clots. Could it be just as effective in treating cancer?
In an editorial published today in the New England Journal of Medicine, researchers from McMaster University and the University at Buffalo suggest conclusive answers to key questions on the benefits of low molecular weight heparin (LMWH) for cancer patients remain elusive - despite promising results from large studies...."

Editorial: Routine Heparin for Patients with Cancer? One Answer, More Questions — NEJM

Editorial

Routine Heparin for Patients with Cancer? One Answer, More Questions

N Engl J Med 2012; 366:661-662February 16, 2012

This article has no abstract; the first 100 words appear below. (requires subscription $$$)

The antithrombotic effect of heparins is established, and it is speculated that a direct antitumor effect of heparin might translate into a survival benefit in patients with cancer.

This antitumor activity of heparins mechanistically includes the inhibition of cell–cell interaction by blocking cell-adhesion molecules (selectins), the inhibition of extracellular-matrix protease heparanase, and the inhibition of angiogenesis.¹

Should heparin, thus, be offered to patients with cancer who have no standard indication for anticoagulation therapy?

A large, randomized clinical trial addressing this question is reported by Agnelli and colleagues in this issue of the Journal.² The SAVE-ONCO study (ClinicalTrials.gov number, NCT00694382) . . .

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

Source Information

From the Department of Medicine, State University of New York at Buffalo, Buffalo (E.A.A.); and the Departments of Clinical Epidemiology and Biostatistics (E.A.A., H.J.S.) and Medicine (H.J.S.), McMaster University, Hamilton, ON, Canada.

Low-Molecular-Weight Heparin and Mortality in Acutely Ill Medical Patients — NEJM (Lovenox (enoxaparin)

full free access: PROTECT study - Dalteparin versus Unfractionated Heparin in Critically Ill Patients — NEJM (venous thromboembolism-blood clots)

"Venous thromboembolism is an important complication of critical illness.....cont'd

The PROTECT Investigators for the Canadian Critical Care Trials Group and the Australian and New Zealand Intensive Care Society Clinical Trials Group

Methods - Study Design

The trial was conducted in 67 ICUs in academic and community hospitals in Canada, Australia, Brazil, Saudi Arabia, the United States, and the United Kingdom. Recruitment began in May 2006 and, as projected, was completed in 4 years. The trial protocol is available with the full text of this article at NEJM.org.7

Cochrane Collaboration review: Elastic compression stockings for prevention of deep vein thrombosis

Background

One of the settings where deep vein thrombosis (DVT) in the lower limb and pelvic veins occurs is in hospital with prolonged immobilisation of patients for various surgical and medical illnesses. Using graduated compression stockings (GCS) in these patients has been proposed to decrease the risk of DVT.

Objectives

To determine the magnitude of effectiveness of GCS in preventing DVT in various groups of hospitalised patients.

Authors' conclusions

GCS are effective in diminishing the risk of DVT in hospitalised patients. Data examination also suggests that GCS on a background of another method of prophylaxis is more effective than GCS on its own.

Plain language summary

Elastic compression stockings for prevention of deep vein thrombosis during a hospital stay
Hospital patients can develop deep vein thrombosis (DVT) in the legs and pelvic veins immediately after surgery or if they are not mobile because of a medical illness. Symptoms vary from none to pain and swelling in the legs. A blood clot can move from the leg to the lungs with the danger of pulmonary embolism and death. Usually the DVT clears up or has long term effects such as high venous pressure in the leg, leg pain, swelling, darkening of the skin or inflammation.

DVT can be prevented using compression or drugs but drugs may cause bleeding, which is a particular concern in surgical patients. Graduated elastic compression stockings help prevent blood clots forming in the legs by applying varying amounts of pressure to different parts of the leg. Our review confirmed that graduated compression stockings reduce the risk of DVT in hospitalised patients. Our findings also suggest that wearing elastic stockings as well as receiving another method of prophylaxis has increased benefit. We identified 18 randomised controlled trials, eight comparing wearing stockings to no stockings and 10 comparing stockings plus another method with that method alone in patients undergoing surgery. The other methods used were Dextran 70, aspirin, heparin and mechanical sequential compression.