Should low molecular weight heparin be used in cancer treatment?

February 15, 2012, McMaster University

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 , researchers from McMaster University and the University at Buffalo suggest conclusive answers to key questions on the benefits of low heparin (LMWH) for remain elusive - despite promising results from large studies.

Co-authors of the editorial are Dr. Elie Akl, associate professor in the Department of Medicine in UB's School of Medicine and and in McMaster University's Department of Clinical Epidemiology and , and Dr. Holger Schünemann, professor of medicine and chair of the Department of and Biostatistics, McMaster University.

In their editorial, on a paper in the same issue of the journal, the physicians say the anti-clotting effect of heparin is well established, unlike a speculated anti-tumor effect. Consequently, they question if heparin should be offered to cancer patients who don't have clotting problems.

Having systematically summarized the available evidence of how cancer patients may benefit from heparin in a 2011 Cochrane Review, they now were invited to comment on the SAVE-ONCO study of 3,200 patients with metastatic or locally advanced solid tumors. Patients receiving chemotherapy were also given a preventive dose of semuloparin (ultra-low-molecular weight ) once daily for just over three months.

This study, the largest so far, found semuloparin significantly reduced the incidence of thromboembolism but had no statistically significant effect on major bleeding and death. Taken together with the prior studies and another study they recently identified these findings confirm and further establish the authors' recent review's conclusion of "a likely small survival benefit."

They estimated "if 1,000 patients with cancer were to use a prophylactic dose of LMWH, approximately 30 would avert death, 20 would avert a clotting complication and one would suffer a major bleeding episode over a 12-month period."

Akl and Schünemann said the findings have meaning for both patients and other healthcare decision makers.

"Patients who are not bothered much by daily injections of LMWH can avert hospitalizations for a clotting complication and possibly achieve a prolongation of life if they accept an increased risk of bleeding and its subsequent treatment," they said.

They added that those patients truly looking for survival from their cancer will need to deal with "some uncertainty" about whether their type and stage of cancer are associated with the likely survival benefit of LMWH.

Akl and Schünemann said more clarity is required about which cancer patients would benefit most, the magnitude of this survival benefit, and whether this benefit is appropriate for cancers that respond poorly to other therapies. They are planning a sophisticated analysis of the published trials (individual patient data meta-analysis) to investigate these questions.

Explore further: Blood thinner may protect cancer patients from potentially fatal clots

Related Stories

Blood thinner may protect cancer patients from potentially fatal clots

June 7, 2011
A new type of anti-clotting drug called semuloparin has been found to reduce the development of potentially fatal blood clots in the veins that often occur in cancer patients, doctors at Duke Cancer Institute and elsewhere ...

Study finds injectable treatment for blood clots in advanced cancer patients increases

February 14, 2012
The use of an injectable, clot-preventing drug known as Low Molecular Weight Heparin to treat patients with advanced cancer complicated by blood clots increased steadily between 2000 and 2007, according to a new study published ...

Cancer patients with blood clots gain no benefit from adding IVCF to fondaparinux

July 7, 2011
Cancer patients with blood clots -- which occur in one of every 200 cancer patients and are the second most common cause of death among cancer patients -- gain no benefit from the insertion of an inferior vena cava filter ...

ACP recommends new approach to prevent venous thromboembolism in hospitalized patients

October 31, 2011
In a new clinical practice guideline published today in Annals of Internal Medicine, the American College of Physicians (ACP) recommends that doctors assess the risk of thromboembolism and bleeding in patients hospitalized ...

Recommended for you

T-cells engineered to outsmart tumors induce clinical responses in relapsed Hodgkin lymphoma

January 16, 2018
WASHINGTON-(Jan. 16, 2018)-Tumors have come up with ingenious strategies that enable them to evade detection and destruction by the immune system. So, a research team that includes Children's National Health System clinician-researchers ...

Researchers identify new treatment target for melanoma

January 16, 2018
Researchers in the Perelman School of Medicine at the University of Pennsylvania have identified a new therapeutic target for the treatment of melanoma. For decades, research has associated female sex and a history of previous ...

More evidence of link between severe gum disease and cancer risk

January 16, 2018
Data collected during a long-term health study provides additional evidence for a link between increased risk of cancer in individuals with advanced gum disease, according to a new collaborative study led by epidemiologists ...

Researchers develop a remote-controlled cancer immunotherapy system

January 15, 2018
A team of researchers has developed an ultrasound-based system that can non-invasively and remotely control genetic processes in live immune T cells so that they recognize and kill cancer cells.

Dietary fat, changes in fat metabolism may promote prostate cancer metastasis

January 15, 2018
Prostate tumors tend to be what scientists call "indolent" - so slow-growing and self-contained that many affected men die with prostate cancer, not of it. But for the percentage of men whose prostate tumors metastasize, ...

Pancreatic tumors may require a one-two-three punch

January 15, 2018
One of the many difficult things about pancreatic cancer is that tumors are resistant to most treatments because of their unique density and cell composition. However, in a new Wilmot Cancer Institute study, scientists discovered ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.