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Published on: September 01, 2011
Dr. Zwicker is the principle investigator of the MicroTEC trial at Beth Israel Deaconess Medical Center.
Rationale: The MicroTEC and PHACS studies target primary thromboprophylaxis to high-risk cancer outpatients. The rationale for the MicroTEC study is based on the observation that elevated levels of circulating tissue-factor bearing microparticles represent a significant risk factor for development of venous thromboembolic events in cancer patients.1 Similarly, Khorana and colleagues developed a risk model that stratifies outpatients with cancer into risk categories based on site of cancer, hemoglobin concentration, platelet count, leukocyte count, and body mass index.2
Comment: Although it is well established that patients with cancer have an abnormally high rate of thrombosis, a standard approach to anticoagulant prophylaxis in the setting of malignancy has yet to emerge. Recently, two large phase III trials demonstrated efficacy in primary thromboprophylaxis using low-molecular-weight heparins in cancer patients, with a 2 percent absolute reduction in venous thromboembolic events observed.3,4 The MicroTEC and PHACS studies are designed to target anticoagulation in high-risk cancer populations either by measuring a biomarker of thrombotic risk (tissue factor-bearing microparticles) or by using a validated risk model. By aiming at a defined target population, the efficacy of thromboprophylaxis in patients with cancer may be improved beyond that observed in unstratified patient populations.
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