Paliatívna medicína a liečba bolesti 1e/2016

Anticoagulation in cancer patients in palliative care

Venous thromboembolism (VTE) is a frequent complication and an important source of morbidity and mortality in advanced cancer patients in palliative care. These patients are often also at increased risk of bleeding. Primary prophylaxis of VTE is recommended for hospitalized cancer patiens with a good performance status and those undergoing active oncologic therapy. There is no evidence of benefit of prophylaxis for patients with life expectancy shorter than 3 months. Treatment of symptomatic VTE is recommended even in patients with limited survival with the exception of those who are imminently dying. The first choise drug is low-molecular weight heparin, which is safer and more efficient than coumarins. The final decision about anticoagulation therapy in a particular patient should be the result of a careful consideration of performance status, life expectancy, individual risks and benefits and the preferences of well informed patient.

Keywords: palliative care, thromboembolism, anticoagulation, low-molecular weight heparin