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Antithrombotic therapy in cancer

BMJ 1999; 318 doi: (Published 12 June 1999) Cite this as: BMJ 1999;318:1571

Low molecular weight heparins may have a direct effect on tumours

  1. A K Kakkar, MRC clinician scientist fellow,
  2. R C N Williamson, Professor of surgery (
  1. Department of Gastrointestinal Surgery, Imperial College School of Medicine, Hammersmith Hospital, London W12 0NN

    Two recent studies from Scandinavia 1 2 have reinforced the clear association between thrombosis and malignant disease that was first recognised by Trousseau in the 19th century.3 These population based analyses of cancer risk involved about 86 000 patients with venous thromboembolism, 4200 of whom had cancer. The observed incidence of cancer (especially pancreatic and ovarian) was 1.3 times the expected incidence among the Danish patients with either deep vein thrombosis or pulmonary embolus and 3.2 times the incidence among the Swedish patients. As a corollary, patients with established cancer are at increased risk of venous thromboembolism, which is potentially fatal. Patients with cancer are nearly twice as likely to die of pulmonary embolism in hospital as those with benign disease, and about 60% of these deaths occur prematurely.4 The hypercoagulable state of malignancy reflects tumour elaboration of tissue factor, the physiological procoagulant.5 Might antithrombotic treatment help reduce this high risk in patients with cancer?

    The risk of thrombosis is further increased when patients receive therapeutic interventions for their cancer. …

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