Prophylactic heparin in palliative care: ...to a challenging idea

doi:10.1136/bmj.332.7543.729

BMJ 2006;332:729 (25 March), doi:10.1136/bmj.332.7543.729

Letter

Prophylactic heparin in palliative care

...to a challenging idea

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

EDITOR—Twenty eight (100%) hospice inpatients at leastfive days into thromboprophylaxis with low molecular weightheparin found it acceptable.¹ The potential for lengthened lifeappeared the main reason for wanting prophylaxis and none knewany common symptoms of venous thromboembolism. All had irreversibledeteriorations in performance status, and, as cancer itselfis a risk for venous thromboembolism, any case for low molecularweight heparins for hospice inpatients logically continues forlife.

Such thromboprophylaxis in advanced cancer does not improveone year survival.² It possibly reduces the risk of symptomaticvenous thromboembolism by 20% but bleeding complications riseby 80%. Administering low molecular weight heparin to 190 patientswith advanced cancer might prevent one symptomatic venous thromboembolism.Based on these figures, our charity's annual drug costs wouldincrease by roughly 28% (£6970; ${euro}$ 10 051; $12 245) to providelow molecular weight heparin to all our inpatients, and theassociated . . . [Full text of this article]

John C Chambers, Macmillan consultant

Katharine House Hospice, Adderbury, Oxfordshire OX17 3NL dr.ch@mbers.info

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