Prevention and Treatment of Thrombotic Complications in Cancer Patients

Patients with malignancies are at high risk of thrombotic events complicating treatment and worsening survival. Currently, parenteral anticoagulants underlie specific prevention of cancer-related thromboembolic complications. Parenteral fondaparinux sodium deserves a special attention as a synthetic selective inhibitor of factor Xa. Randomized studies revealed similar effectiveness of fondaparinux sodium with minimal risk of major bleedings in VTE complications compared to LMWH in surgery cancer patients. «Start the next morning» mode of anticoagulation with fondaparinux in cancer patients reduces the risk of massive bleeding without reducing effectiveness. A meta-analysis of 12 randomized controlled trials demonstrated that fondaparinux was more effective than low molecular weight heparins regarding total clinical benefit. This anticoagulant is also effective and safe for the treatment of VTE. In addition, fondaparinux is safer in patients with low platelet count. Reduced dose (1.5 mg/day) is safe in patients over 85 years old, with renal failure and creatinine clearance 20—50 ml/min.