Thrombo-embolic events in cancer patients with impaired renal function

Venous Thromboembolism (VTE) is a frequent cause of mortality and morbidity in patients with malignancy. Thrombosis is one of the leading causes of death in patients with malignancy after cancer itself. As such, prompt recognition and treatment of VTE are required in order to reduce the risk of VTE-related mortality. This report reviews the interrelationship between cancer, renal insufficiency and VTE. The working group behind this review article concludes that Low Molecular Weight Heparins (LMWHs) decrease the risk of recurrent venous thrombosis in cancer patients without increasing major bleeding complications. LMWHs are therefore recommended as first line antithrombotic treatment in cancer patients with a clear clinical benefit. In patients with renal dysfunction, who are at both increased risk of bleeding and of thrombotic complications, preference should be given to unfractionated heparin or a LMWH with a mean molecular weight such as tinzaparin, having less risk of plasma accumulation and offering the possibility to maintain full therapeutic dose.