Clinical Experience of Nadroparin in Patients with Cancer

Clinical Experience of Nadroparin in Patients with Cancer

Franco Piovella, Marisa Barone


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Anticoagulant drugs represent an essential therapeutic class in patients with cancer, venous thromboembolism being one of the most common complications occurring during the evolution of this disease.1 Among the available drugs, oral vitamin K antagonists are not ideally suited to this patient group owing to the presence of factors that may influence the stability of the anticoagulant effect (including drug interactions, malnutrition, vomiting and liver dysfunction).

In contrast, due to their high level of efficacy and safety and their ease of use, low-molecular-weight heparins are particularly appropriate in patients with cancer. Therefore, the use of these drugs is recommended in a number of international guidelines on the prevention and treatment of venous thromboembolism in this group of patients.2–4 Furthermore, a promising aspect of low-molecular-weight heparins in patients with cancer is that these drugs may prolong the survival of these patients independently of their therapeutic effect on thrombosis. Among the available low-molecular-weight heparins, nadroparin is one of the most studied for the prevention and treatment of venous thromboembolism in patients with cancer. Nadroparin is also the first low-molecular-weight heparin that has been shown to prolong the survival of cancer patients without venous thromboembolism.5 In this manuscript, we review the nadroparin studies in order to present clinical evidence supporting the use of this drug in cancer patients.

Nadroparin and the Prevention of Venous Thromboembolism in Patients with Cancer
Cancer is a major risk factor for venous thromboembolism.6 For example, the incidence of venous thromboembolism is about two times higher in patients hospitalised with cancer than in patients hospitalised without cancer.7 Moreover, approximately 15% of patients with cancer develop symptomatic venous thromboembolism during the course of their disease.8 The thrombotic risk varies according to cancer type, with the tumour sites most commonly associated with venous thromboembolism being the brain, ovary, digestive tract, pancreas, bone and lung.7,9–12 Thrombotic risk is highest in the first few months after cancer diagnosis; it increases with advancing cancer stage and the presence of metastases.11–15 Furthermore, cancer patient management involves procedures that favour the development of thrombosis, including surgery, the administration of chemotherapy or hormonal therapy, the use of invasive procedures and long-term placement of central venous catheters.12,14,16,17 Due to the ageing population, rising incidence of cancer and increasing use of invasive procedures, venous thromboembolic events associated with cancer, particularly pulmonary embolism, are becoming more common.12,18 The development of venous thromboembolism in the course of this disease adversely affects not only the quality of life of patients with cancer, but also the overall prognosis. The probability of death in cancer patients with venous thromboembolism is higher than that in patients with cancer alone or venous thromboembolism alone.19–21 Thus, venous thromboembolism is the second cause of death in patients with cancer.22 Furthermore, it is the most common cause of death at 30 days post-surgery.23

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