Thromboembolieprophylaxe mit dalteparin-Na (Fragmin®) bei onkologischen patienten nach port-implantationen

Background and Question: Low-molecular-weight heparins (LMWH) have established themselves in thromboprophylaxis. Guidelines of the German Society of Phlebology emphasize that patients with cancer and long term subclavian catheters are at highest risk for thrombosis. The patient numbers in investigations so far have been low, however. The aim of this prospective observation study was therefore to investigate for the first time the efficacy and tolerability of thromboprophylaxis using the LMWH dalteparin-Na (Fragmin®) in a larger sized population of such patients under everyday conditions. Methods: 197 patients with malignancy were examined in an observational study prospectively and multicentric during and after implantation of a port system. Thromboprophylaxis was given subcutaneously as 2,500 IU or 5,000 IU dalteparin-Na daily. Dosage and duration of prophylaxis was determined at the discretion of the physicians depending on the individual risk of thrombosis. The observation period was at least 90 days in the presence of a port-system. Results: Dalteparin-Na was applied on average for a period of 76 days. Thromboses were seen in 7 of 135 patients (5.2%) receiving 2,500 IU dalteparin-Na and in 2 of 62 patients (3.2%) receiving 5,000 IU dalteparin-Na, whereby two further thromboses occurred after discontinuation of prophylaxis. 45% of the thromboses were diagnosed in the first month. The incidence of side effects was low, with only one clinically relevant incident of bleeding (0.5%). The general tolerability of dalteparin-Na was assessed as "good" in 193 patients (98%). Conclusions: Perioperative and postoperative thromboembolic prophylaxis with 2,500 IU and 5,000 IU dalteparin-Na in oncologically indicated port-systems proved to be efficient and well tolerated. As thromboses were also seen at later dates, medicinal prophylaxis in patients with a catheter should be administered over a period of at least three months.