Prophylactic anti-coagulation in cancer palliative care: a prospective randomised study

Weber, Catherine ; Merminod, Thierry ; Herrmann, François ; Zulian, Gilbert

In: Supportive Care in Cancer, 2008, vol. 16, no. 7, p. 847-852

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    Summary
    Goals: The objective of this study was to determine utility of prophylactic anti-coagulation in cancer patients hospitalised for palliative care in a specialised centre. Materials and methods: Prospective 1:1 open randomised study was designed. Twenty patients aged 55 to 88years with advanced cancer and an estimated life expectancy of less than 6months were assigned to either receive treatment with 2,850/3,800U (<70/>70kg) of daily subcutaneous nadroparin or no treatment. Suspicion of venous thrombo-embolism (deep vein thrombosis and pulmonary embolism) was confirmed by echo-Doppler examination of the lower limbs and/or by spiral computed tomography scan of the lungs. Bleeding episodes were recorded. Platelet count was measured on days 7 and 14. Survival time from study entry was determined. Main results: One venous thrombo-embolism and one major bleeding occurred in the group receiving nadroparin, whereas two minor bleedings occurred in the control group. At 3months, nine of ten participants had died in the control group vs five of ten in the group receiving nadroparin (P = 0.141). Five participants could be discharged home (P = 0.141). Conclusions: Decision to administer prophylactic nadroparin in hospitalised cancer patients under palliative care remains a challenge. Better mobility score at admission and the likelihood to be discharged home may be useful for practical purposes. The observation of a potential influence of prophylactic nadroparin on survival deserves further studies