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Review
. 2010 Apr 13;102 Suppl 1(Suppl 1):S24-9.
doi: 10.1038/sj.bjc.6605602.

Antithrombotic therapy and survival in patients with malignant disease

A K Kakkar  1 , F Macbeth
Affiliations
Review

Antithrombotic therapy and survival in patients with malignant disease

A K Kakkar et al. Br J Cancer. .

Abstract

A broad range of studies suggest a two-way relationship between cancer and venous thromboembolism (VTE). Patients with cancer have consistently been shown to be at elevated risk for VTE; this risk is partly driven by an intrinsic hypercoagulable state elicited by the tumour itself. Conversely, thromboembolic events in patients without obvious risk factors are often the first clinical manifestation of an undiagnosed malignancy. The relationship between VTE and cancer is further supported by a number of trials and meta-analyses which, when taken together, strongly suggest that antithrombotic therapy can extend survival in patients with cancer by a mechanism that extends beyond its effect in preventing VTE. Moreover, accumulating evidence from in vitro and in vivo studies has shown that tumour growth, invasion, and metastasis are governed, in part, by elements of the coagulation system. On 22 May 2009, a group of health-care providers based in the United Kingdom met in London, England, to examine recent advances in cancer-associated thrombosis and its implications for UK clinical practice. As part of the discussion, attendees evaluated evidence for and against an effect of antithrombotic therapy on survival in cancer. This paper includes a summary of the data presented at the meeting and explores potential mechanisms by which antithrombotic agents might exert antitumour effects. The summary is followed by a consensus statement developed by the group.

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Conflict of interest statement

AK Kakkar has received consulting fees from Bayer, Sanofi-aventis, Boehringer Ingelheim, Pfizer, Bristol-Myers Squibb, and Eisai. F Macbeth has received grant support from CRUK and Pfizer.

Figures

Figure 1
Figure 1
(A) Survival curves for the intent-to-treat population enrolled in the FAMOUS trial; (B) survival curves for the subgroup of patients with better prognosis who survived beyond 17 months after randomisation (Kakkar et al, 2004).
Figure 2
Figure 2
(A) Probability of survival in all patients with advanced solid malignancy according to assignment to nadroparin or placebo; (B) probability of survival in patients with advanced solid malignancy with a life expectancy of ⩾6 months at enrollment, according to assignment to nadroparin or placebo (Klerk et al, 2005).
Figure 3
Figure 3
One- and 2-year mortality in cancer patients randomised to LMWH vs placebo/no intervention (Lazo-Langner et al, 2007).
See this image and copyright information in PMC

Comment in

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