The impact of thromboprophylaxis with LMWHs on the survival of patients with pancreatic cancer. Issue 213 (May 2022)

• Record Type: Journal Article
• Authors: Sarantis, Panagiotis; Karamouzis, Michalis V.
• Is Part Of: Thrombosis research. Issue 213(2022)Supplement 1
• Page Start: S120
• Page End: S126
• Publication Date: 2022-05
• Subjects: Pancreatic cancer -- Venous thromboembolism -- Low molecular weight heparins -- Thromboprophylaxis; ASCO American Society of Clinical Oncology -- ASH American Society of Hematology -- CDDP cisplatinum -- CrCl creatinine clearance -- DOACs direct oral anticoagulants -- DVT deep vein thrombosis -- ECM extracellular matrix -- FGF-2 fibroblast growth factor 2 -- FOLFIRINOX Oxaliplatin–Irinotecan–Fluorouracil–Calcium Folinate -- GEM gemcitambine -- GI gastro-intestinal -- GU genitourinary -- HIF-1a hypoxia-inducible factor 1a -- HIT heparin-induced thrombocytopenia -- ITAC International Initiative on Thrombosis in Cancer -- LMWHs low molecular weight heparins -- NCCN National Comprehensive Cancer Network -- N-P nab-paclitaxel -- OS overall survival -- PAR-2 protease-activated receptor-2 -- PC pancreatic cancer -- PE pulmonary embolism -- PFS progression-free survival -- TFPI tissue factor pathway inhibitor -- TSP-1 thrombospondin-1 -- UFH unfractionated heparin -- VEGF vascular endothelial growth factor -- VKA vitamin K antagonist -- VTE venous thromboembolism -- VVT visceral vein thrombosis; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2022.02.004
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Pancreatic cancer (PC) is the fourth leading cause of cancer-related deaths, with a five-year survival rate of less than 10%. Venous thromboembolism (VTE) occurs in 20% of PC patients and is associated with a dismal prognosis and reduced survival. VTE is considered the second leading cause of death in these patients and the median time from PC diagnosis to VTE occurrence is 4.49 months. For these reasons, there is an emergent need for the optimization of supportive care. Low molecular weight heparins (LMWHs) have played a quite important role in thromboprophylaxis in recent years in comparison to other anticoagulants such as unfractionated heparin and DOACs. The main advantages of their use in clinical practice are the low occurrence of heparin-induced thrombocytopenia (HIT), limited post-administration bleeding events, as well as the possibility of self-administration, via subcutaneous injection. In addition, numerous studies have shown their role in reducing the incidence of VTE and prolonging the survival of patients, without bleeding events. There are recent studies suggesting that LMWHs in combination with chemotherapy contribute to a greater survival of pancreatic cancer patients, due to their properties against tumor progression and metastatic dissemination. In conclusion, they could act as a complementary treatment to provide prolonged survival and improved quality of life for PC patients. Highlights: VTE occurs in 20% of PC patients and is associated with reduced survival. LMWH is one of the main anticoagulant options for thromboprophylaxis. LMWHs have in vitro and in vivo antitumor and antimetastatic properties. Co-administration of LMWHs and chemotherapy might improve survival in PC patients.