The National Comprehensive Cancer Network (NCCN) recently issued guidelines recommending inpatient prophylactic anticoagulation therapy with unfractionated heparin, low-molecularweight heparin (LMWH), or fondaparinux. The guidelines do not address outpatient prophylaxis, but they suggest immediate and long-term treatment once an episode of venous thromboembolism (VTE) occurs. The NCCN recommends 3 to 6 months of treatment for deep vein thrombosis, 6 to 12 months of treatment for pulmonary embolism, and indefinite treatment for patients with active cancer or persistent risk factors.
The NCCN recommends the use of LMWH or warfarin for long-term treatment and secondary prevention. Preliminary data suggest an improved survival benefit using LMWH, however. The new guidelines may be accessed at www.nccn.org/professionals/physician_gls/sPDF/vte.pdf.
Dr. Garrett is a clinical pharmacist practitioner at Cornerstone Health Care in High Point, NC.
One study linked multiple pregnancies to an increased risk of developing atrial fibrillation later in life, and another investigated the association between premature delivery and cardiovascular disease.
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