ABSTRACT
Patients with hematologic malignancies have increased risks of thromboembolism or
bleeding. The commonest thrombotic complication is venous thromboembolism (VTE). Other
thrombotic conditions occur in association with specific disorders, such as thrombotic
thrombocytopenic purpura in hematopoietic stem cell transplantation and disseminated
intravascular coagulation in acute promyelocytic leukemia. Clinical trials show that
unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are efficacious
for VTE prophylaxis in cancer patients after major surgery or when hospitalized for
acute medical illnesses. These findings in cancer patients are probably applicable
to patients with hematologic malignancies, in whom there are very few studies. However,
the effectiveness of anticoagulant VTE prophylaxis is not established in ambulatory
patients with cancer except for multiple myeloma patients treated with thalidomide
and chemotherapy. LMWH is widely used as initial treatment for VTE because it enables
home therapy without laboratory monitoring, thereby improving the patient's quality
of life. UFH is preferred in patients with high bleeding risks and renal impairment.
In cancer patients, vitamin K antagonists for the long-term treatment of VTE are increasingly
replaced by LMWH, which show superior efficacy. When prescribing anticoagulant prophylaxis
or treatment to patients with hematologic malignancies, clinical benefits must be
weighed carefully against the risks of bleeding.
KEYWORDS
Thromboembolism - hematologic malignancy - heparin - coumadin
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Beng H Chong
Level 2, Pitney Building, St. George Hospital
Gray St., Kogarah, New South Wales 2217, Australia
Email: beng.chong@unsw.edu.au
