BMJ  2006;332:728-729 (25 March), doi:10.1136/bmj.332.7543.728-b

Letter

Prophylactic heparin in palliative care

A cautious welcome...

The first 150 words of the full text of this article appear below.

EDITOR—Although we agree with the conclusions of the survey reported by Noble et al of patients' views on receiving low molecular weight heparin in palliative care, we wish to sound some notes of caution.1 Reasons other than preciousness about patients' comfort lie behind a reluctance to give many patients in palliative care prophylactic treatment with low molecular weight heparin.

In advanced cancer the procoagulant state is not temporary, as after surgery. Progression of disease is also associated with worsening mobility, sometimes venous obstruction by tumour masses, and sometimes poor hydration. Therefore if it is logical to put patients on heparin while in an institutional setting, it would be illogical to stop this when they go home. This means problems associated with long term heparin administration beyond the economic and manpower issues (see full version on bmj.com). The benefits and risks of low molecular weight heparin in the . . . [Full text of this article]

Victor Pace, consultant in palliative medicine

St Christopher's Hospice, London SE26 6DZ
v.pace@stchristophers.org.uk

Emma Hall, consultant in palliative medicine, Catherine Bailey, specialist registrar

St Christopher's Hospice, London SE26 6DZ


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Relevant Article

Acceptability of low molecular weight heparin thromboprophylaxis for inpatients receiving palliative care: qualitative study
S I R Noble, A Nelson, C Turner, and I G Finlay
BMJ 2006 332: 577-580. [Abstract] [Full Text] [PDF]

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