Dosing: VTE in Solid Tumours

Active malignancy is associated with a 4–7 fold increase in venous thromboembolism (VTE) compared to patients without cancer^1,2. Approximately 15% of patients with cancer develop future symptomatic VTE, and those with idiopathic VTE have up to a 4-fold increased risk of malignancy in the first year after VTE diagnosis.² These cancers are likely to be advanced and are associated with a 3-fold increase in mortality². For these patients, anticoagulation is an important consideration

Indication:

The extended treatment of symptomatic VTE and prevention of its recurrence in patients with solid tumours³

Recommended duration of treatment is 6 months; continuing treatment beyond this period should be evaluated according to individual risk/benefit ratio, taking into account the progression of cancer.

NICE clinical guidelines recommend offering low molecular weight heparins, such as Fragmin, to patients with active cancer and confirmed proximal deep vein thrombosis  (DVT) or pulmonary embolism (PE) for 6 months. At 6 months, the patient should be reevaluated⁴

Dosing regimen suitable for most solid tumour patients:

Once-daily, weight-adjusted monotherapy for 6 months³
Maximum daily dose – 18,000 IU**≈

No dose adjustment in the elderly

Dose adjustments are required in patients with low platelet counts.  For further information about dose reduction or interruption in patients with chemotherapy -induced thrombocytopenia, please refer to SPC.

Platelets should be measured before starting Fragmin and monitored closely in the first 3 weeks and regularly thereafter during treatment³
 
Monitoring of the anticoagulant effect is not usually necessary³

In the case of significant renal failure (defined as CrCl <30 ml/min), the dose of Fragmin should be adjusted based on anti-factor Xa activity

Please refer to the SmPC for monitoring within specific patient groups