This site contains promotional information intended only for healthcare professionals resident in the United Kingdom
Menu
Close
Example of description text sitting alongside header
Example of description text sitting alongside header
Menu
Close
Example of description text sitting alongside header
Example of description text sitting alongside header
Menu
Close
Adverse event reporting can be found at the bottom of the page
Prescribing information for Fragmin® (dalteparin sodium) can be found here. Adverse event reporting can be found at the bottom of the page.
VTE is a leading cause of death for patients with cancer.2
Clinically evident VTE has been noted in up to 15% of patients with cancer which could be even higher if considering subclinical disease.2
In addition, cancer patients are also more likely to have recurrent VTE, including when they are on appropriate anticoagulants.2
In-hospital mortality for patients with cancer and VTE is over twice that of mortality for matched patients without VTE.2
However, individual patient risk factors can vary significantly so careful consideration is needed when selecting the best course of treatment to manage VTE risk.2
Patients with cancer have a 4-fold higher risk of VTE than individuals without cancer but over the course of a patient’s cancer journey, the risk of VTE can fluctuate based on treatment-related factors.3
Many cancer therapies (including major surgery, aggressive chemotherapy, and hormonal therapy) appear to place patients with cancer at further increased risk for VTE, so it is critical to consider concurrent anticoagulation in patients being treated for cancer. 3
But VTE is also a marker for occult cancer. In the general population, up to 10% of people with a first-time VTE have a subsequent cancer diagnosis within a year.1
So, if someone presents with VTE and there is no obvious cause, what should you think as a clinician?
Figure1: Adapted from Lyman GH, 2011.3
Tumours and cancer treatments can cause abnormalities in venous stasis, vessel damage and induce hypercoagulability – which can predispose cancer patients to VTE.1,2,4
Virchow’s triad illustrates how, in cancer patients, these three components contribute to VTE risk.
If anticoagulant treatment can treat hypercoagulability, what about the other two factors? Which anticoagulant should you use in certain circumstances? And when is best to begin treatment?
There are many questions which remain and there is not one rule which fits all circumstances.
BUT...Choosing the right anticoagulant could be fundamental to minimising VTE risk and a positive outcome in your cancer patients.2
Anticoagulation treatment must be tailored to each individual, taking into consideration other potential risk factors.4,6
We have explored that VTE risk is heightened in cancer patients. But what is it specifically that puts these patients at risk?
Cancer, treatment and patient-related factors can all influence VTE risk which requires assessing on an individual basis.7
These may include:*
You should consider using a risk assessment tool (such as the Khorana tool) to assess your patient’s risk of VTE and always use the anticoagulant SmPC to assess special warnings, precautions for use and interactions.2
Potential drug-drug interactions, cancer treatment regime and type of cancer may influence your choice of anticoagulant.
*Table information is a general guide only. Specific assessment of a patient or interpretation of any results should relate to local guidelines and policies.
VTE risk is not evenly spread across all patients with cancer.2
The Khorana risk assessment tool states that stomach and pancreatic cancers are very high risk for VTE and Cohen et al. showed that pancreatic cancer had the highest incidence of VTE closely followed by cancer in the brain and ovaries.2,8
Patients with haematological malignancies, particularly lymphoma and myeloma are also at increased risk. So, improved survival with anticoagulation may be dependent on tumour type and disease stage.2,3
Be aware of which types of cancer put patients at most risk of VTE and monitor them closely.
The American Society of Haematology state in their recommendations (with moderate certainty) that low molecular weight heparins should be used over direct oral anticoagulants in the immediate, short and long-term treatment in cancer patients with diagnosed VTE.9
Therefore, emphasis should be placed on considering all risk factors for each individual patient.
It is important to pay close attention to decreasing the risk of VTE while maximising efficacy of treatment in your patients.2
Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard or search
for MHRA Yellow Card in Google Play or Apple App Store
Adverse events should also be reported to Pfizer Medical Information on 01304 616161
To access further materials, resources and receive communication about medicines and vaccines promoted by Pfizer.
This site is intended only for healthcare professionals resident in the United Kingdom. If you are a member of the public wishing to access information on a specific medicine, please visit www.medicines.org.uk/emc
This website is brought to you by Pfizer Limited, a company registered in England
and Wales under No. 526209 with its registered office at Ramsgate Road, Sandwich, Kent, CT13 9NJ
Copyright © 2024 Pfizer Limited. All rights reserved.
VAT registration number GB201048427
These pages are not intended for patients or for members of the general public. The healthcare professional web pages contain promotional content.
I confirm that I am a healthcare professional* resident in the United Kingdom.
If you select 'No', you will be redirected to Pfizer.co.uk where you will be able to access reference information on Pfizer's prescription medicines.
*The ABPI Code definition for healthcare professional is members of the medical, dental, pharmacy and nursing professionals and any other persons who in the course of their professional activities may administer, prescribe, purchase, recommend or supply a medicine.
PP-UNP-GBR-7812. January 2024